title: Development and internal validation of a multivariable model to predict perinatal death in pregnancy hypertension.
abstract: OBJECTIVE
  To develop and internally validate a prognostic model for perinatal death that could guide community-based antenatal care of women with a hypertensive disorder of pregnancy (HDP) in low-resourced settings as part of a mobile health application.
  
  
  METHODS
  Using data from 1688 women (110 (6.5%) perinatal deaths) admitted to hospital after 32weeks gestation with a HDP from five low-resourced countries in the miniPIERS prospective cohort, a logistic regression model to predict perinatal death was developed and internally validated. Model discrimination, calibration, and classification accuracy were assessed and compared with use of gestational age alone to determine prognosis.
  
  
  METHODS
  Stillbirth or neonatal death before hospital discharge.
  
  
  RESULTS
  The final model included maternal age; a count of symptoms (0, 1 or ⩾2); and dipstick proteinuria. The area under the receiver operating characteristic curve was 0.75 [95% CI 0.71-0.80]. The model correctly identified 42/110 (38.2%) additional cases as high-risk (probability >15%) of perinatal death compared with use of only gestational age <34weeks at assessment with increased sensitivity (48.6% vs. 23.8%) and similar specificity (86.6% vs. 90.0%).
  
  
  CONCLUSIONS
  Using simple, routinely collected measures during antenatal care, we can identify women with a HDP who are at increased risk of perinatal death and who would benefit from transfer to facility-based care. This model requires external validation and assessment in an implementation study to confirm performance.
authors.affiliation: Department of Obstetrics and Gynaecology and the CFRI Reproductive and Healthy Pregnancy Cluster, University of British Columbia, Vancouver, Canada. Electronic address: bpayne@cw.bc.ca.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Payne
authors.affiliation: Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Henk
authors.initials: H
authors.lastname: Groen
authors.affiliation: Department of Obstetrics and Gynaecology and the CFRI Reproductive and Healthy Pregnancy Cluster, University of British Columbia, Vancouver, Canada.
authors.forename: U Vivian
authors.initials: UV
authors.lastname: Ukah
authors.affiliation: Department of Obstetrics and Gynaecology and the CFRI Reproductive and Healthy Pregnancy Cluster, University of British Columbia, Vancouver, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada.
authors.forename: J Mark
authors.initials: JM
authors.lastname: Ansermino
authors.affiliation: Division of Women and Child Health, Aga Khan University, Karachi, Pakistan; Hospital for Sick Children Centre for Global Health, University of Toronto, Toronto, Canada.
authors.forename: Zulfiqar
authors.initials: Z
authors.lastname: Bhutta
authors.affiliation: Department of Obstetrics and Gynecology, Feinberg School of Medicine Northwestern University, Chicago, USA.
authors.forename: William
authors.initials: W
authors.lastname: Grobman
authors.affiliation: Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
authors.forename: David R
authors.initials: DR
authors.lastname: Hall
authors.affiliation: Department of Obstetrics and Gynaecology and the CFRI Reproductive and Healthy Pregnancy Cluster, University of British Columbia, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Hutcheon
authors.affiliation: Department of Obstetrics and Gynaecology and the CFRI Reproductive and Healthy Pregnancy Cluster, University of British Columbia, Vancouver, Canada; Department of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Magee
authors.affiliation: Department of Obstetrics and Gynaecology and the CFRI Reproductive and Healthy Pregnancy Cluster, University of British Columbia, Vancouver, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D005260:Female; D017359:HELLP Syndrome / Q000453:epidemiology; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D007231:Infant, Newborn; D066087:Perinatal Death; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D047928:Premature Birth / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology
keywords: Low-resourced setting; Perinatal death; Pre-eclampsia; Prognosis; Stillbirth