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Women with immune thrombocytopenia (ITP) are at increased risk of developing PPH. Early identification of PPH helps to prevent adverse outcomes, but is underused because clinicians do not have a tool to predict PPH for women with ITP. We therefore conducted a nationwide multicenter retrospective study to develop and validate a prediction model of PPH in patients with ITP. We included 432 pregnant women (677 pregnancies) with primary ITP from 18 academic tertiary centers in China from January 2008 to August 2018. A total of 157 (23.2%) pregnancies experienced PPH. The derivation cohort included 450 pregnancies. For the validation cohort, we included 117 pregnancies in the temporal validation cohort and 110 pregnancies in the geographical validation cohort. We assessed 25 clinical parameters as candidate predictors and used multivariable logistic regression to develop our prediction model. The final model included seven variables and was named MONITOR (<jats:styled-content>m<\/jats:styled-content>aternal complication, WH<jats:styled-content>O<\/jats:styled-content> bleeding score, a<jats:styled-content>n<\/jats:styled-content>tepartum platelet transfusion, placental abnormal<jats:styled-content>i<\/jats:styled-content>ties, pla<jats:styled-content>t<\/jats:styled-content>elet count, previ<jats:styled-content>o<\/jats:styled-content>us uterine surgery, and p<jats:styled-content>r<\/jats:styled-content>imiparity). We established an easy\u2010to\u2010use risk heatmap and risk score of PPH based on the seven risk factors. We externally validated this model using both a temporal validation cohort and a geographical validation cohort. The MONITOR model had an AUC of 0.868 (95% CI 0.828\u20130.909) in internal validation, 0.869 (95% CI 0.802\u20130.937) in the temporal validation, and 0.811 (95% CI 0.713\u20130.908) in the geographical validation. Calibration plots demonstrated good agreement between MONITOR\u2010predicted probability and actual observation in both internal validation and external validation. Therefore, we developed and validated a very accurate prediction model for PPH. We hope that the model will contribute to more precise clinical care, decreased adverse outcomes, and better health care resource allocation.<\/jats:p>","DOI":"10.1002\/ajh.26134","type":"journal-article","created":{"date-parts":[[2021,2,21]],"date-time":"2021-02-21T01:36:37Z","timestamp":1613871397000},"page":"561-570","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Prediction of postpartum hemorrhage in pregnant women with immune thrombocytopenia: Development and validation of the <scp>MONITOR<\/scp> model in a nationwide multicenter study"],"prefix":"10.1002","volume":"96","author":[{"given":"Qiu\u2010Sha","family":"Huang","sequence":"first","affiliation":[{"name":"Peking University People's Hospital, Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Collaborative Innovation Center of Hematology; Beijing Key Laboratory of Hematopoietic Stem Cell 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