{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:58:04Z","timestamp":1791266284990,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2014,10,10]],"date-time":"2014-10-10T00:00:00Z","timestamp":1412899200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J of Obstet and Gynaecol"],"published-print":{"date-parts":[[2015,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Identify women at risk of severe post\u2010partum hemorrhage (<jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content>) by building a prediction model based on clinical variables available at <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content> diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed data on a cohort of 7236 women with <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content> after vaginal delivery from 106 maternity units. Severe <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content> was defined as the loss of more than 2000\u2009mL of blood, peripartum drop in hemoglobin of 4\u2009g\/dL or more, transfusion of at least four packed red blood cells, embolization, hemostasis surgery, transfer to an intensive care unit or death. The <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>kaike criterion helped selecting the covariates of a multivariate logistic regression model. The performance of the model was studied through building a receiver\u2013operator curve (<jats:styled-content style=\"fixed-case\">ROC<\/jats:styled-content>). The relative utility of the final model was used to determine the importance of the model in decision\u2010making.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among all <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content>, the prevalence of severe cases was 18.5%. Several clinical variables were significantly associated with severe <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content> (e.g. parity, multiple pregnancy, labor induction, instrumental delivery). The multivariate prediction model was built. The area under the <jats:styled-content style=\"fixed-case\">ROC<\/jats:styled-content> for prediction of severe cases was 0.63 (95% confidence interval, 0.62\u20130.65). Nevertheless, the sensitivity and specificity of the prediction model were 0.49 and 0.70, respectively, for a threshold at 0.20 (near prevalence). The relative utility was 0.19 for a threshold near prevalence (20%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Because of important misclassifications, even the best model we could build with the available clinical data cannot be reasonably recommended for routine use. Every patient with <jats:styled-content style=\"fixed-case\">PPH<\/jats:styled-content> should receive most optimal management. Other types of information, possibly laboratory data, are probably needed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jog.12528","type":"journal-article","created":{"date-parts":[[2014,10,10]],"date-time":"2014-10-10T05:39:30Z","timestamp":1412919570000},"page":"199-206","source":"Crossref","is-referenced-by-count":18,"title":["Severity of post\u2010partum hemorrhage after vaginal delivery is not predictable from clinical variables available at the time post\u2010partum hemorrhage is diagnosed"],"prefix":"10.1111","volume":"41","author":[{"given":"Marion","family":"Cortet","sequence":"first","affiliation":[{"name":"Department of Biostatistics Hospices Civils de Lyon  Lyon France"},{"name":"University of Lyon  Lyon France"},{"name":"University of Lyon 1  Villeurbanne France"},{"name":"UMR 5558 Laboratory of Biometry and Evolutionary Biology Team of Health and Biostatistics National Center for Scientific Research  Villeurbanne France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delphine","family":"Maucort\u2010Boulch","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Hospices Civils de Lyon  Lyon France"},{"name":"University of Lyon  Lyon France"},{"name":"University of Lyon 1  Villeurbanne France"},{"name":"UMR 5558 Laboratory of Biometry and Evolutionary Biology Team of Health and Biostatistics National Center for Scientific Research  Villeurbanne France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Deneux\u2010Tharaux","sequence":"additional","affiliation":[{"name":"INSERM U953 Epidemiological Research Unit on Perinatal Health and Women's and Children's Health Pierre and Marie Curie University Paris 6  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinne","family":"Dupont","sequence":"additional","affiliation":[{"name":"Aurore Perinatal Network Hospital of Croix\u2010Rousse Hospices Civils de Lyon  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren\u00e9\u2010Charles","family":"Rudigoz","sequence":"additional","affiliation":[{"name":"EA Sant\u00e9\u2010Individu\u2010Soci\u00e9t\u00e9 4129 University of Lyon  Lyon France"},{"name":"Aurore Perinatal Network Hospital of Croix\u2010Rousse Hospices Civils de Lyon  Lyon France"},{"name":"Department of Gynecology and Obstetrics Hospices Civils de Lyon  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Roy","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Hospices Civils de Lyon  Lyon France"},{"name":"University of Lyon  Lyon France"},{"name":"University of Lyon 1  Villeurbanne France"},{"name":"UMR 5558 Laboratory of Biometry and Evolutionary Biology Team of Health and Biostatistics National Center for Scientific Research  Villeurbanne 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