title: Prediction of escape red blood cell transfusion in expectantly managed women with acute anaemia after postpartum haemorrhage.
abstract: OBJECTIVE
  To determine clinical predictors of escape red blood cell (RBC) transfusion in postpartum anaemic women, initially managed expectantly, and the additional predictive value of health-related quality of life (HRQoL) measures.
  
  
  METHODS
  Secondary analysis of women after postpartum haemorrhage, either randomly allocated to, or opting for expectant management.
  
  
  METHODS
  Thirty-seven hospitals in the Netherlands.
  
  
  METHODS
  A total of 261 randomised and 362 nonrandomised women.
  
  
  METHODS
  We developed prediction models to assess the need for RBC transfusion: one using clinical variables (model 1), and one extended with scores on the HRQoL-measures Multidimensional Fatigue Inventory (MFI) and EuroQol-5D (model 2). Model performance was assessed by discrimination and calibration. Models were internally validated with bootstrapping techniques to correct for overfitting.
  
  
  METHODS
  Escape RBC transfusion.
  
  
  RESULTS
  Seventy-five women (12%) received escape RBC transfusion. Independent predictors of escape RBC transfusion (model 1) were primiparity, multiple pregnancy, total blood loss during delivery and haemoglobin concentration postpartum. Maternal age, body mass index, ethnicity, education, medical indication of pregnancy, mode of delivery, preterm delivery, placental removal, perineal laceration, Apgar score and breastfeeding intention had no predictive value. Addition of HRQoL-scores (model 2), significantly improved the model's discriminative ability: c-statistics of model 1 and 2 were 0.65 (95% CI 0.58-0.72) and 0.72 (95% CI 0.65-0.79), respectively. The calibration of both models was good.
  
  
  CONCLUSIONS
  In postpartum anaemic women, several clinical variables predict the need for escape RBC transfusion. Adding HRQoL-scores improves model performance. After external validation, the extended model may be an important tool for counselling and decision making in clinical practice.
authors.affiliation: Department of Gynaecology and Obstetrics, Maasstad Hospital, Rotterdam, the Netherlands.|Department of Obstetrics, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: B W
authors.initials: BW
authors.lastname: Prick
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands.|Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands.|Stanford Prevention Research Center, Stanford University, Stanford, CA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Schuit
authors.affiliation: Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina.
authors.forename: L
authors.initials: L
authors.lastname: Mignini
authors.affiliation: Sanquin Blood Supply Foundation, Rotterdam, the Netherlands.
authors.forename: A J G
authors.initials: AJ
authors.lastname: Jansen
authors.affiliation: Sanquin Blood Supply Foundation, Rotterdam, the Netherlands.
authors.forename: D J
authors.initials: DJ
authors.lastname: van Rhenen
authors.affiliation: Department of Obstetrics, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: E A P
authors.initials: EA
authors.lastname: Steegers
authors.affiliation: School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia.
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Obstetrics, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Duvekot
mesh_terms: D000208:Acute Disease; D000328:Adult; D000740:Anemia / Q000628:therapy*; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006304:Health Status; D006801:Humans; D009426:Netherlands; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D011379:Prognosis; D011788:Quality of Life; D012044:Regression Analysis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Anaemia; blood transfusion; postpartum haemorrhage; prediction model; red blood cell transfusion