A contemporary perspective on predicting early postpartum hemorrhage: risk factor stratification for developing a predictive scoring system

BACKGROUND: Early postpartum hemorrhage is a life-threatening complication that requires emergency care and a multidisciplinary approach. In addition to the main etiological causes of hemorrhage (the 4T concept), the influence of other factors has been identified, the study of which allows for the development of predictive scoring systems, differentiated preventive strategies, and minimization of the risk of early postpartum hemorrhage.

AIM: To identify factors influencing the development of early postpartum hemorrhage, stratify the obtained data, and develop a risk assessment scoring system for this complication.

METHODS: A retrospective case–control study was conducted. The main group (n = 219) included women whose deliveries were complicated by early postpartum hemorrhage, whereas the control group (n = 219) consisted of women without postpartum hemorrhage. A list of potential factors determining the risk of postpartum hemorrhage (comprising 38 parameters in total) was compiled. The effect of each parameter on hemorrhage risk was assessed using odds ratios with 95% confidence intervals, p values for statistical significance, and the Student t test. Logistic regression analysis was used to stratify the impact of predictors on the development of early postpartum hemorrhage.

RESULTS: Statistical analysis identified 25 factors that significantly increased the risk of postpartum hemorrhage. Oligohydramnios at the time of hospitalization increased the risk of postpartum hemorrhage by 1.6 times, polyhydramnios by 1.7 times, premature rupture of membranes by 1.7 times, class I obesity by 1.9 times, class II obesity by 2.2 times, gestational diabetes mellitus by 2.0 times, and the presence of a uterine scar after cesarean delivery or myomectomy by 2.2 times. Using logistic regression analysis and odds ratio data, these predictors were successfully stratified and integrated into a unified scoring system for assessing the risk of early postpartum hemorrhage.

CONCLUSION: The proposed risk stratification score for postpartum hemorrhage serves as a clinical decision support tool in urgent settings, enabling rapid and objective assessment of early postpartum hemorrhage risk, timely implementation of preventive measures, and improvement of maternal outcomes.