{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:54:13Z","timestamp":1791986053080,"version":"4.4.0"},"reference-count":22,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["UG1 HD087230"],"award-info":[{"award-number":["UG1 HD087230"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["UG1 HD027869"],"award-info":[{"award-number":["UG1 HD027869"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["UG1 HD027915"],"award-info":[{"award-number":["UG1 HD027915"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["UG1 HD034208"],"award-info":[{"award-number":["UG1 HD034208"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["UG1 HD040500"],"award-info":[{"award-number":["UG1 HD040500"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["UG1 HD040485"],"award-info":[{"award-number":["UG1 HD040485"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["UG1 HD053097"],"award-info":[{"award-number":["UG1 HD053097"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["UG1 HD040544"],"award-info":[{"award-number":["UG1 HD040544"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["UG1 HD040545"],"award-info":[{"award-number":["UG1 HD040545"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["UG1 HD040560"],"award-info":[{"award-number":["UG1 HD040560"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["UG1 HD040512"],"award-info":[{"award-number":["UG1 HD040512"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["UG1 HD087192"],"award-info":[{"award-number":["UG1 HD087192"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["U24 HD036801"],"award-info":[{"award-number":["U24 HD036801"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pregnancy"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cesarean delivery is a major risk factor for postpartum hemorrhage. A priority for postpartum hemorrhage safety bundles is the assessment of hemorrhage and transfusion risk following cesarean delivery and the identification of patients at increased risk for postpartum hemorrhage requiring red blood cell transfusion. A prediction model based on antenatal and intrapartum risk factors could be used in a standardized manner among all patients when considering crossmatch or other preparatory measures prior to cesarean delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop a multivariable prediction model for red blood cell transfusion associated with cesarean delivery using a prospective contemporary cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Secondary analysis of a multicenter trial of tranexamic acid (TXA) versus placebo for the prevention of red blood cell transfusion after cesarean delivery was performed. The primary outcome for this analysis was transfusion of packed red blood cells by hospital discharge or 7 days postpartum, whichever came first. Maternal characteristics and risk factors related to labor were compared between patients who received a transfusion and those who did not. Any of the characteristics that differed with a\n                      <jats:italic>p<\/jats:italic>\n                      value\u00a0&lt;0.05 were considered in a multivariable model. Model selection and internal validation were performed using\n                      <jats:italic>k<\/jats:italic>\n                      \u2010fold cross\u2010validation. Using backward elimination, variables that remained significant at\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05 were retained in each model. The final model was chosen based on the highest area under the receiver operating characteristic curve (ROC) in the validation set.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 418 of 10,961 patients (3.8%) received a red blood cell transfusion. Factors associated with transfusion and retained in the final model included gestational age at delivery\u00a0&lt;34\u00a0weeks or\u00a0\u226541\u00a0weeks, chorioamnionitis, aspirin use in the week before delivery, preoperative hemoglobin level, preoperative platelet count\u00a0&lt;100,000, oxytocin duration, and cesarean delivery during the second stage of labor. The final multivariable model had excellent discrimination with an area under the curve (AUC) of 0.79 (95% confidence interval [CI], 0.76, 0.81). Using the same set of seven factors identified in the prediction model for transfusion, the AUC was 0.62 (95% CI, 0.60, 0.65) for differentiating patients who did and did not require surgical\/radiological interventions in response to bleeding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We identified several factors associated with risk of red blood cell transfusion during\/after cesarean delivery and a model with excellent predictive ability. Risk factors in this model, including lower preoperative hemoglobin level, aspirin use\u00a0&lt;7 days before delivery, and delivery during the second stage of labor, may be used to risk\u2010stratify patients for preparation for transfusion to reduce postoperative complications that result from bleeding.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmf2.70249","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T22:44:43Z","timestamp":1773009883000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A model to predict red blood cell transfusion during\/after cesarean delivery"],"prefix":"10.1002","volume":"2","author":[{"given":"Samuel","family":"Parry","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Perelman School of Medicine at the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven J.","family":"Weiner","sequence":"additional","affiliation":[{"name":"Department of Epidemiology The George Washington University Biostatistics Center Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George R.","family":"Saade","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology The University of Texas Medical Branch Galveston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca G.","family":"Clifton","sequence":"additional","affiliation":[{"name":"Department of Epidemiology The George Washington University Biostatistics Center Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"John M.","family":"Thorp","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Longo","sequence":"additional","affiliation":[{"name":"The Eunice Kennedy Shriver National Institute of Child Health and Human Development  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Salazar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology The University of Texas Medical Branch Galveston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Dalton","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Case Western Reserve University Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan T. N.","family":"Tita","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology The University of Alabama at Birmingham Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Gyamfi\u2010Bannerman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Columbia University New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suneet P.","family":"Chauhan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, The Texas Health Science Center at Houston Children's Memorial Hermann Hospital Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torri D.","family":"Metz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Utah Health Sciences Center Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8504-6715","authenticated-orcid":false,"given":"Kara","family":"Rood","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology The Ohio State University Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dwight J.","family":"Rouse","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Brown University Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1489-9190","authenticated-orcid":false,"given":"Jennifer L.","family":"Bailit","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Case Western Reserve University Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William A.","family":"Grobman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Northwestern University Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyagriv N.","family":"Simhan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology The University of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George A.","family":"Macones","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology The University of Texas at Austin Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis D.","family":"Pacheco","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology The University of Texas Medical Branch Galveston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal\u2010Fetal Medicine Units Network","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2022.08.003"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004361"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102393\u20109\u201055"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181954e5b"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.2450\/2020.0319\u201019"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.04.243"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000173"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2022.07.024"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003759"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.2196\/34108"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100039\u20101678604"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1055\/a\u20102234\u20108171"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2207419"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2021.100404"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471\u20100528.16379"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250\u2010199406000\u201000004"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199803123381101"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199310213291701"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.07.023"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100040\u20101718581"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1055\/a\u20102096\u20105199"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2023.100878"}],"container-title":["Pregnancy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmf2.70249","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pmf2.70249","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmf2.70249","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:43:39Z","timestamp":1791985419000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/pmf2.70249"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,24]]},"references-count":22,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1002\/pmf2.70249"],"URL":"https:\/\/doi.org\/10.1002\/pmf2.70249","archive":["Portico"],"relation":{},"ISSN":["2997-9684","2997-9684"],"issn-type":[{"value":"2997-9684","type":"print"},{"value":"2997-9684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,24]]},"assertion":[{"value":"2025-09-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70249"}}