Poster Session 3
Category: Labor
Poster Session 3
Or Bercovich, BSc, MD (he/him/his)
Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, HaMerkaz, Israel
Ophir Blickstein, MD
Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, HaMerkaz, Israel
Lior Friedrich, MD
Intern
Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
Petah Tikva, HaMerkaz, Israel
Karolin Sokolik, MD
Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva
Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, HaMerkaz, Israel
Yossi Geron, MD
Helen Schneider Hospital for Women, Rabin Medical Center
Petah Tikva, HaMerkaz, Israel
Ohad Houri, MD, MSc (he/him/his)
Doctor
BCNatal Fetal Medicine Research Center
BARCELONA, Catalonia, Spain
Daniela Chen, MD
Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva
Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, HaMerkaz, Israel
To develop a predictive model and nomogram for postpartum hemorrhage (PPH) following term vaginal delivery.
Study Design:
This retrospective study was conducted at a single tertiary care center. We included all vaginal deliveries at ≥37 gestational weeks (either normal vaginal delivery [NVD] or vacuum extraction [VE]) recorded between July 2012 to December 2023. The primary outcome was the occurrence of PPH, defined as bleeding that, in the clinician’s judgment, exceeded physiological norms and posed a threat to maternal stability, thereby necessitating medical or surgical intervention. The full multivariate logistic regression included variables such as age, BMI, parity, diabetes, hypertensive disorders, chorioamnionitis, polyhydramnios, mode of delivery, gestational age, birthweight, oxytocin use, second-stage duration, and neuraxial analgesia. The stepwise model, selected based on the Akaike Information Criterion, retained the variables gestational age (GA), clinical weight estimation at delivery, mode of delivery (NVD or VE), use of intrapartum oxytocin, and the duration of the second stage of labor. A nomogram was constructed based on the final logistic regression model. Internal validation and calibration were performed.
Results:
A total of 29,094 vaginal deliveries met the inclusion criteria, of which 978 cases (3.4%) were complicated by PPH. The final logistic regression model showed that higher gestational age (p < 0.001), higher clinical fetal weight estimation (p = 0.008), vacuum-assisted delivery (p < 0.001), use of oxytocin (p = 0.022), and longer second stage (p < 0.001) were all independently associated with increased odds of PPH. Their respective predicted probabilities are represented in the nomogram (Figure 1).
Conclusion:
The developed nomogram provides a clinically useful tool for individualized risk prediction of PPH after term vaginal birth. This may assist clinicians in identifying patients at higher risk and optimizing postpartum management strategies accordingly.