title: Inability to predict postpartum hemorrhage: insights from Egyptian intervention data.
abstract: BACKGROUND
  Knowledge on how well we can predict primary postpartum hemorrhage (PPH) can help policy makers and health providers design current delivery protocols and PPH case management. The purpose of this paper is to identify risk factors and determine predictive probabilities of those risk factors for primary PPH among women expecting singleton vaginal deliveries in Egypt.
  
  
  METHODS
  From a prospective cohort study, 2510 pregnant women were recruited over a six-month period in Egypt in 2004. PPH was defined as blood loss ≥ 500 ml. Measures of blood loss were made every 20 minutes for the first 4 hours after delivery using a calibrated under the buttocks drape. Using all variables available in the patients' charts, we divided them in ante-partum and intra-partum factors. We employed logistic regression to analyze socio-demographic, medical and past obstetric history, and labor and delivery outcomes as potential PPH risk factors. Post-model predicted probabilities were estimated using the identified risk factors.
  
  
  RESULTS
  We found a total of 93 cases of primary PPH. In multivariate models, ante-partum hemoglobin, history of previous PPH, labor augmentation and prolonged labor were significantly associated with PPH. Post model probability estimates showed that even among women with three or more risk factors, PPH could only be predicted in 10% of the cases.
  
  
  CONCLUSIONS
  The predictive probability of ante-partum and intra-partum risk factors for PPH is very low. Prevention of PPH to all women is highly recommended.
authors: Bixby Center for Population, Health and Sustainability, School of Public Health, University of California at Berkeley, 229 Warren Hall, UC-Berkeley, Berkeley, CA 94720-7360, USA. ndola@berkeley.edu
authors: Ndola
authors: N
authors: Prata
authors: Sabry
authors: S
authors: Hamza
authors: Suzanne
authors: S
authors: Bell
authors: Deborah
authors: D
authors: Karasek
authors: Farnaz
authors: F
authors: Vahidnia
authors: Martine
authors: M
authors: Holston
mesh_terms: D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008427:Maternal Health Services; D006473:Postpartum Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors