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ORIGINAL ARTICLE
Year : 2019  |  Volume : 3  |  Issue : 4  |  Page : 230-234

Postpartum hemorrhage following cesarean delivery in women with a scarred uterus: A retrospective cohort study


1 Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University; Key Laboratory of Maternal-Fetal Medicine, China Medical University; Research Center of China Medical University Birth Cohort, Shenyang 110004, China
2 Research Center of China Medical University Birth Cohort, Shenyang 110004, China

Correspondence Address:
Chong Qiao
Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang 110004
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2096-2924.274548

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Objective: To develop a model to predict the risk of postpartum hemorrhage (PPH) following cesarean delivery in women with a scarred uterus. Methods: A total of 4,637 pregnant women with scarred uterus who underwent a cesarean delivery at a large hospital between January 2014 and December 2017 were enrolled. The women were divided into PPH (n = 287) and non-PPH (n = 4,350) groups. A model to predict PPH (blood loss ≥1,000 mL within 24 h following cesarean delivery) was developed using multivariate logistic regression analysis. Receiver operating characteristic curve was drawn, and the area under curve (AUC) was calculated. Results: The incidence of PPH was 6.19% (287 of 4,637 women). Seven independent risk factors were associated with PPH: maternal age (odds ratio [OR] = 1.42, 95% confidence interval [CI]: 1.02–1.97), previous gravidity (OR = 1.24, 95% CI: 1.01–1.50), placental location (posterior wall of uterus, OR = 0.69, 95% CI: 0.47–1.02; other locations, OR = 1.21, 95% CI: 0.81–1.80), placenta previa (incomplete placenta previa, OR = 10.51, 95% CI: 5.99–18.42; complete placenta previa, OR = 31.65, 95% CI: 21.07–47.54), placenta accreta (OR = 6.39, 95% CI: 4.02–10.16), hypertensive disorders of pregnancy (OR = 2.27, 95% CI: 1.40–3.68), and fetal position (breech position, OR = 2.07, 95% CI: 1.19–3.60; transverse position, OR = 1.07, 95% CI: 0.48–2.41). A predictive model with AUC of 0.89 was developed (95% CI: 0.86–0.91, P < 0.001). Conclusions: A model was developed to predict PPH following cesarean delivery in women with a scarred uterus.


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