BACKGROUND Postpartum hemorrhage(PPH)is a leading cause of maternal mortality,and hysterectomy is an important intervention for managing intractable PPH.Accurately predicting the need for hysterectomy and taking proac...BACKGROUND Postpartum hemorrhage(PPH)is a leading cause of maternal mortality,and hysterectomy is an important intervention for managing intractable PPH.Accurately predicting the need for hysterectomy and taking proactive emergency measures is crucial for reducing mortality rates.AIM To develop a risk prediction model for PPH requiring hysterectomy in the ethnic minority regions of Qiandongnan,China,to help guide clinical decision-making.METHODS The study included 23490 patients,with 1050 having experienced PPH and 74 who underwent hysterectomies.The independent risk factors closely associated with the necessity for hysterectomy were analyzed to construct a risk prediction model,and its predictive efficacy was subsequently evaluated.RESULTS The proportion of hysterectomies among the included patients was 0.32%(74/23490),representing 7.05%(74/1050)of PPH cases.The number of deliveries,history of cesarean section,placenta previa,uterine atony,and placenta accreta were identified in this population as independent risk factors for requiring a hysterectomy.Receiver operating characteristic curve analysis of the prediction model showed an area under the curve of 0.953(95%confidence interval:0.928-0.978)with a sensitivity of 90.50%and a specificity of 90.70%.CONCLUSION The model demonstrates excellent predictive power and is effective in guiding clinical decisions regarding PPH in the ethnic minority regions of Qiandongnan,China.展开更多
Objective To measure the accuracy of postpartum hemorrhage(PPH)risk assessment performed by unaided individual clinicians,to inform future comparison to alternative risk assessment methods.Methods Prospective PPH risk...Objective To measure the accuracy of postpartum hemorrhage(PPH)risk assessment performed by unaided individual clinicians,to inform future comparison to alternative risk assessment methods.Methods Prospective PPH risk assessments were collected from obstetric care team clinicians at two quaternary medical centers in the United States(Vanderbilt University Medical Center,Brigham and Women’s Hospital)from January 2022 to January 2023,following written informed consent from the providers.The data included a cohort of both vaginal and cesarean deliveries(CD).For each assessment,the clinician quantified the patient’s predicted PPH risk on a scale from 0 to 100%and rated their confidence in these assessments using a 5-point Likert scale,ranging from‘not at all confident’to‘completely confident’.Medical records were reviewed 24 hours postpartum to assess the dichotomous outcome of PPH,defined as blood loss≥1000 mL.The accuracy of these predictions was evaluated using the area under the receiver operating characteristic curve(AUC).Results Of 271 patients,32(11.8%)experienced PPH,accounting for 11.4%(104/915)of assessments.The overall AUC was 0.64(95%confidence interval(CI):0.58–0.71).Prediction accuracy was higher for CD than for vaginal deliveries,with AUCs of 0.82(95%CI:0.72–0.91)and 0.56(95%CI:0.48–0.63),respectively.No significant differences in the accuracy of assessments were observed according to physician specialty,physician experience level,or confidence level of the assessment.Conclusion Overall unaided clinician performance in predicting PPH was moderate,with an AUC of 0.64.Predictions were more accurate for patients undergoing CD.Further study is needed to understand how clinician performance compares to other modalities of risk prediction.展开更多
Early postpartum hemorrhage is one of the major causes of maternal death in the world especially in developing countries. Its management often relieves resuscitation that is often difficult to set up in our countries ...Early postpartum hemorrhage is one of the major causes of maternal death in the world especially in developing countries. Its management often relieves resuscitation that is often difficult to set up in our countries and sometimes based on invasive and mutilate surgery. Objectives: The purpose of this survey was to report frequency of this pathology, to describe its management and the factors that influence the prognosis of early postpartum hemorrhage in low setting health in Africa. Method: Authors conducted a prospective study that analyzed early postpartum hemorrhage in the motherhoods of Gabriel Touré teaching hospital and community five health reference center of the district of Bamako. It took place from January, 2015 to December, 2016. The study concerned all the cases of early postpartum hemorrhage according to WHO definition. Statistical tests used were X2 or Fisher test, its 95% confidence interval (CI95%), p value was significant if Results: Early postpartum hemorrhage frequency has been 0.7% (62 cases for 8.885 deliveries). Sixty nine and one percent (69.1%) of patients have been blood fluid transfused. Obstetric treatment dominated by uterine revision (30.7%). Hysterorraphy (4.0%), hysterectomy (3.0%), suture of uterus injuries (15.7%), hypo gastric artery ligature (2.0%) and B-Lynch compression suture (2.0%) have been the main practiced surgical operations. No satisfy blood transfusion need was 26.9%. The main risk factors of early PPH were high parity (p = 0009;RR = 3.04;CI95% [2.80 - 5.11]), prolonged labor (p = 0004;RR = 4.00;CI95% [3.06 - 10.02]), oxytocin/prostaglandin use (p = 0003;RR = 1.47;CI95% [1.17 - 3.16]). Eleven of maternal occurred (11.8%). Conclusion: Early postpartum hemorrhage is still a severe event in developing countries especially. Its management sometime consisted to invasive cares. Maternal prognosis that is influenced by unsatisfied blood need and late management is marked by high lethality.展开更多
目的:系统评价中国人群产后出血(PPH)发生的危险因素。方法:计算机检索中国知网、万方数据库、Pubmed和Web of Science数据库,搜集有关PPH危险因素的研究,检索时限均为2003年1月—2023年1月,由2名研究者独立筛选文献、提取资料并评价纳...目的:系统评价中国人群产后出血(PPH)发生的危险因素。方法:计算机检索中国知网、万方数据库、Pubmed和Web of Science数据库,搜集有关PPH危险因素的研究,检索时限均为2003年1月—2023年1月,由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:共纳入14个研究,包括3957例患者。Meta分析结果显示:前置胎盘、胎盘植入、巨大儿(≥4000 g)、剖宫产、年龄≥35岁、流产史、孕前体质量(BMI)≥24 kg/m^(2)、宫缩乏力、中重度贫血、产次≥2次、胎盘早剥、妊娠期高血压、产程延长和多胎妊娠是中国人群产后出血发生的危险因素。结论:我国女性PPH的发生与上述多种危险因素有关。医护人员在临床上应重视对PPH潜在危险因素的筛查,早期发现和识别高危因素并提前做好准备工作是减少PPH的根本所在。展开更多
Background Postpartum hemorrhage(PPH)could be avoided by identifying high-risk women.The objective of this systematic review is to determine PPH predictors using machine learning(ML)approaches.Method This strategy inc...Background Postpartum hemorrhage(PPH)could be avoided by identifying high-risk women.The objective of this systematic review is to determine PPH predictors using machine learning(ML)approaches.Method This strategy included searching for studies from inception through November 2022 through the database included:Cochrane Central Register,PubMed,MEDLINE,EMBASE,ProQuest,Scopus,WOS,IEEE Xplore,and the Google Scholar database.The search methodology employed the PICO framework(population,intervention,control,and outcomes).In this study,“P”represents PPH populations,“I”represents the ML approach as intervention,“C”represents the traditional statistical analysis approach as control,and“O”represents prediction and diagnosis outcomes.The quality assessment of each included study was performed using the PROBAST methodology.Results The initial search strategy resulted in 2048 citations,which were subsequently refined by removing duplicates and irrelevant studies.Ultimately,four studies were deemed eligible for inclusion in the review.Among these studies,three were classified as having a low risk of bias,while one was considered to have a low to moderate risk of bias.A total of 549 unique variables were identified as candidate predictors from the included studies.Nine distinct models were chosen as ML algorithms from the four studies.Each of the four studies employed different metrics,such as the area under the curve,false positive rate,false negative rate,and sensitivity,to report the accuracy of their models.The ML models exhibited varying accuracies,with the area under the curve(AUC)ranging from 0.706 to 0.979.Several weighted predictors were identified as significant factors in PPH risk prediction.These included pre-pregnancy maternal weight,maternal weight at the time of admission,fetal macrosomia,gestational age,level of hematocrit at the time of admission,shock index,frequency of contractions during labor,white blood cell count,pregnancy-induced hypertension,the weight of the newborn,duration of the second stage of labor,amniotic fluid index,body mass index,and cesarean delivery before labor.These factors were determined to have a notable influence on the prediction of PPH risk.Conclusion The findings from ML models used to predict PPH are highly encouraging.展开更多
Objective:To investigate the risk factors of severe postpartum hemorrhage(PPH)in cesarean section of twin pregnancy,and to provide clinical basis for pregnancy management and perioperative obstetric management of twin...Objective:To investigate the risk factors of severe postpartum hemorrhage(PPH)in cesarean section of twin pregnancy,and to provide clinical basis for pregnancy management and perioperative obstetric management of twin pregnancy.Methods:The clinical data of 631 twin pregnancies with gestational age28 weeks delivered by cesarean section at Peking University People's Hospital(PKUPH)from January 2004 to January 2017 were retrospectively analyzed.Methods of conception,the combined weight of twins,serum albumin level before cesarean section,operation time and other factors on the amount of blood loss during cesarean section were analyzed.Results:The proportion of severe PPH was significantly higher in in vitro fertilization-embryo transfer(IVF-ET)group,the combined weight of twins>6000g group,serum albumin before cesarean section<30 g/dl group than in the natural pregnancy group,4000–6000g group,<4000g group and serum albumin30 g/dl group respectively(P<0.05).The proportion of severe PPH in the elective surgery group of twin pregnancy was higher than that in the emergency surgery group,but the difference was not statistically significant(P>0.05).Moreover,according to the surgical indications,the emergency surgery group was divided into premature rupture of membranes(PROM),labor,fetal distress and others groups,no significant difference were detected among these groups(P>0.05).Conclusion:IVF-ET,the combined weight of twins,serum albumin before operation were significantly correlated with severe PPH of twin pregnancies delivered by cesarean section,revealing that it is necessary to strengthen pregnancy management of twin pregnancy.展开更多
基金Supported by Qiandongnan Prefecture Science and Technology Support Plan,No.[2021]11Training of High Level Innovative Talents in Guizhou Province,No.[2022]201701。
文摘BACKGROUND Postpartum hemorrhage(PPH)is a leading cause of maternal mortality,and hysterectomy is an important intervention for managing intractable PPH.Accurately predicting the need for hysterectomy and taking proactive emergency measures is crucial for reducing mortality rates.AIM To develop a risk prediction model for PPH requiring hysterectomy in the ethnic minority regions of Qiandongnan,China,to help guide clinical decision-making.METHODS The study included 23490 patients,with 1050 having experienced PPH and 74 who underwent hysterectomies.The independent risk factors closely associated with the necessity for hysterectomy were analyzed to construct a risk prediction model,and its predictive efficacy was subsequently evaluated.RESULTS The proportion of hysterectomies among the included patients was 0.32%(74/23490),representing 7.05%(74/1050)of PPH cases.The number of deliveries,history of cesarean section,placenta previa,uterine atony,and placenta accreta were identified in this population as independent risk factors for requiring a hysterectomy.Receiver operating characteristic curve analysis of the prediction model showed an area under the curve of 0.953(95%confidence interval:0.928-0.978)with a sensitivity of 90.50%and a specificity of 90.70%.CONCLUSION The model demonstrates excellent predictive power and is effective in guiding clinical decisions regarding PPH in the ethnic minority regions of Qiandongnan,China.
基金Dr.Farber serves on advisory boards for HemoSonics and Octapharma and receives research funding support from Flat Medical.
文摘Objective To measure the accuracy of postpartum hemorrhage(PPH)risk assessment performed by unaided individual clinicians,to inform future comparison to alternative risk assessment methods.Methods Prospective PPH risk assessments were collected from obstetric care team clinicians at two quaternary medical centers in the United States(Vanderbilt University Medical Center,Brigham and Women’s Hospital)from January 2022 to January 2023,following written informed consent from the providers.The data included a cohort of both vaginal and cesarean deliveries(CD).For each assessment,the clinician quantified the patient’s predicted PPH risk on a scale from 0 to 100%and rated their confidence in these assessments using a 5-point Likert scale,ranging from‘not at all confident’to‘completely confident’.Medical records were reviewed 24 hours postpartum to assess the dichotomous outcome of PPH,defined as blood loss≥1000 mL.The accuracy of these predictions was evaluated using the area under the receiver operating characteristic curve(AUC).Results Of 271 patients,32(11.8%)experienced PPH,accounting for 11.4%(104/915)of assessments.The overall AUC was 0.64(95%confidence interval(CI):0.58–0.71).Prediction accuracy was higher for CD than for vaginal deliveries,with AUCs of 0.82(95%CI:0.72–0.91)and 0.56(95%CI:0.48–0.63),respectively.No significant differences in the accuracy of assessments were observed according to physician specialty,physician experience level,or confidence level of the assessment.Conclusion Overall unaided clinician performance in predicting PPH was moderate,with an AUC of 0.64.Predictions were more accurate for patients undergoing CD.Further study is needed to understand how clinician performance compares to other modalities of risk prediction.
文摘Early postpartum hemorrhage is one of the major causes of maternal death in the world especially in developing countries. Its management often relieves resuscitation that is often difficult to set up in our countries and sometimes based on invasive and mutilate surgery. Objectives: The purpose of this survey was to report frequency of this pathology, to describe its management and the factors that influence the prognosis of early postpartum hemorrhage in low setting health in Africa. Method: Authors conducted a prospective study that analyzed early postpartum hemorrhage in the motherhoods of Gabriel Touré teaching hospital and community five health reference center of the district of Bamako. It took place from January, 2015 to December, 2016. The study concerned all the cases of early postpartum hemorrhage according to WHO definition. Statistical tests used were X2 or Fisher test, its 95% confidence interval (CI95%), p value was significant if Results: Early postpartum hemorrhage frequency has been 0.7% (62 cases for 8.885 deliveries). Sixty nine and one percent (69.1%) of patients have been blood fluid transfused. Obstetric treatment dominated by uterine revision (30.7%). Hysterorraphy (4.0%), hysterectomy (3.0%), suture of uterus injuries (15.7%), hypo gastric artery ligature (2.0%) and B-Lynch compression suture (2.0%) have been the main practiced surgical operations. No satisfy blood transfusion need was 26.9%. The main risk factors of early PPH were high parity (p = 0009;RR = 3.04;CI95% [2.80 - 5.11]), prolonged labor (p = 0004;RR = 4.00;CI95% [3.06 - 10.02]), oxytocin/prostaglandin use (p = 0003;RR = 1.47;CI95% [1.17 - 3.16]). Eleven of maternal occurred (11.8%). Conclusion: Early postpartum hemorrhage is still a severe event in developing countries especially. Its management sometime consisted to invasive cares. Maternal prognosis that is influenced by unsatisfied blood need and late management is marked by high lethality.
文摘Background Postpartum hemorrhage(PPH)could be avoided by identifying high-risk women.The objective of this systematic review is to determine PPH predictors using machine learning(ML)approaches.Method This strategy included searching for studies from inception through November 2022 through the database included:Cochrane Central Register,PubMed,MEDLINE,EMBASE,ProQuest,Scopus,WOS,IEEE Xplore,and the Google Scholar database.The search methodology employed the PICO framework(population,intervention,control,and outcomes).In this study,“P”represents PPH populations,“I”represents the ML approach as intervention,“C”represents the traditional statistical analysis approach as control,and“O”represents prediction and diagnosis outcomes.The quality assessment of each included study was performed using the PROBAST methodology.Results The initial search strategy resulted in 2048 citations,which were subsequently refined by removing duplicates and irrelevant studies.Ultimately,four studies were deemed eligible for inclusion in the review.Among these studies,three were classified as having a low risk of bias,while one was considered to have a low to moderate risk of bias.A total of 549 unique variables were identified as candidate predictors from the included studies.Nine distinct models were chosen as ML algorithms from the four studies.Each of the four studies employed different metrics,such as the area under the curve,false positive rate,false negative rate,and sensitivity,to report the accuracy of their models.The ML models exhibited varying accuracies,with the area under the curve(AUC)ranging from 0.706 to 0.979.Several weighted predictors were identified as significant factors in PPH risk prediction.These included pre-pregnancy maternal weight,maternal weight at the time of admission,fetal macrosomia,gestational age,level of hematocrit at the time of admission,shock index,frequency of contractions during labor,white blood cell count,pregnancy-induced hypertension,the weight of the newborn,duration of the second stage of labor,amniotic fluid index,body mass index,and cesarean delivery before labor.These factors were determined to have a notable influence on the prediction of PPH risk.Conclusion The findings from ML models used to predict PPH are highly encouraging.
文摘Objective:To investigate the risk factors of severe postpartum hemorrhage(PPH)in cesarean section of twin pregnancy,and to provide clinical basis for pregnancy management and perioperative obstetric management of twin pregnancy.Methods:The clinical data of 631 twin pregnancies with gestational age28 weeks delivered by cesarean section at Peking University People's Hospital(PKUPH)from January 2004 to January 2017 were retrospectively analyzed.Methods of conception,the combined weight of twins,serum albumin level before cesarean section,operation time and other factors on the amount of blood loss during cesarean section were analyzed.Results:The proportion of severe PPH was significantly higher in in vitro fertilization-embryo transfer(IVF-ET)group,the combined weight of twins>6000g group,serum albumin before cesarean section<30 g/dl group than in the natural pregnancy group,4000–6000g group,<4000g group and serum albumin30 g/dl group respectively(P<0.05).The proportion of severe PPH in the elective surgery group of twin pregnancy was higher than that in the emergency surgery group,but the difference was not statistically significant(P>0.05).Moreover,according to the surgical indications,the emergency surgery group was divided into premature rupture of membranes(PROM),labor,fetal distress and others groups,no significant difference were detected among these groups(P>0.05).Conclusion:IVF-ET,the combined weight of twins,serum albumin before operation were significantly correlated with severe PPH of twin pregnancies delivered by cesarean section,revealing that it is necessary to strengthen pregnancy management of twin pregnancy.
