Developing and Validating Nomogram to Predict Severe Postpartum Hemorrhage in Women With Placenta Previa Undergoing Cesarean Delivery: A Multicenter Retrospective Case-Control Study

Xiaohe Dang; Li Zhang; Yindi Bao; Jie Xu; Hui Du; Shaoshuai Wang; Yanyan Liu; Dongrui Deng; Suhua Chen; Wanjiang Zeng; Ling Feng; Haiyi Liu

doi:10.3389/fmed.2021.789529

Developing and Validating Nomogram to Predict Severe Postpartum Hemorrhage in Women With Placenta Previa Undergoing Cesarean Delivery: A Multicenter Retrospective Case-Control Study

Front Med (Lausanne). 2022 Feb 11:8:789529. doi: 10.3389/fmed.2021.789529. eCollection 2021.

Authors

Xiaohe Dang¹, Li Zhang², Yindi Bao³, Jie Xu⁴, Hui Du⁵, Shaoshuai Wang¹, Yanyan Liu¹, Dongrui Deng¹, Suhua Chen¹, Wanjiang Zeng¹, Ling Feng¹, Haiyi Liu¹

Affiliations

¹ Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Department of Obstetrics and Gynecology, The Central Hospital of Wuhan, Wuhan, China.
³ Department of Obstetrics, Renmin Hospital of Wuhan University, Wuhan, China.
⁴ Department of Obstetrics, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning, China.
⁵ Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Abstract

Objective: Developing and validating nomogram to predict severe postpartum hemorrhage (SPPH) in women with placenta previa (PP) undergoing cesarean delivery.

Methods: We conducted a multicenter retrospective case-control study in five hospitals. In this study, 865 patients from January, 2018 to June, 2020 were enrolled in the development cohort, and 307 patients from July, 2020 to June, 2021 were enrolled in the validation cohort. Independent risk factors for SPPH were obtained by using the multivariate logistic regression, and preoperative nomogram and intraoperative nomogram were developed, respectively. We compared the discrimination, calibration, and net benefit of the two nomograms in the development cohort and validation cohort. Then, we tested whether the intraoperative nomogram could be used before operation.

Results: There were 204 patients (23.58%) in development cohort and 80 patients (26.06%) in validation cohort experienced SPPH. In development cohort, the areas under the receiver operating characteristic (ROC) curve (AUC) of the preoperative nomogram and intraoperative nomogram were 0.831 (95% CI, 0.804, 0.855) and 0.880 (95% CI, 0.854, 0.905), respectively. In validation cohort, the AUC of the preoperative nomogram and intraoperative nomogram were 0.825 (95% CI, 0.772, 0.877) and 0.853 (95% CI, 0.808, 0.898), respectively. In the validation cohort, the AUC was 0.839 (95% CI, 0.789, 0.888) when the intraoperative nomogram was used before operation.

Conclusion: We developed the preoperative nomogram and intraoperative nomogram to predict the risk of SPPH in women with PP undergoing cesarean delivery. By comparing the discrimination, calibration, and net benefit of the two nomograms in the development cohort and validation cohort, we think that the intraoperative nomogram performed better. Moreover, application of the intraoperative nomogram before operation can still achieve good prediction effect, which can be improved if the severity of placenta accreta spectrum (PAS) can be accurately distinguished preoperatively. We expect to conduct further prospective external validation studies on the intraoperative nomogram to evaluate its application value.

Keywords: multivariate logistic regression; nomogram; placenta previa; prediction model; severe postpartum hemorrhage.