Identifying women most likely to benefit from prevention strategies for postpartum hemorrhage.

OBJECTIVE

To identify women who are most likely to benefit from primary prevention strategies for postpartum hemorrhage (PPH).

STUDY

DESIGN

In a retrospective patient cohort, we applied recursive partitioning algorithms to identify the most discriminant risk factors and their interactions, and calculated the 'number needed to treat' to prevent a single case of PPH (estimated blood loss >1000 ml).

RESULT: By delivery category, the highest risk groups with 'number needed to treat' ranging from 4 to 7 were: (1) vaginal delivery (PPH=0.7% of 16 218)-macrosomia with gestational diabetes and manual removal of the placenta; (2) primary cesarean (PPH=18.7% of 2696)-macrosomia and multiparity; and (3) repeat cesarean (PPH=16.0% of 1832)-uterine incision other than low transverse and failed vaginal birth after cesarean.

CONCLUSION

Clinical profiles that identify women at risk for PPH can provide a foundation for the development of primary prevention strategies.