A novel postpartum hemorrhage prediction model for women with hypertensive disorders of pregnancy in secondary hospitals of middle-income settings
5 affiliations
- 1Xinjiang Medical University
- 2Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute
- 3NHC Key Laboratory of Hypertension Clinical Research
- 4Key Laboratory of Xinjiang Uygur Autonomous Region “Hypertension Research Laboratory”
- 5Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular Diseases)
Abstract
Background: This study aimed to develop and validate a risk-stratification tool to aid clinical referral decision-making for postpartum hemorrhage among women with hypertensive disorders of pregnancy. The tool targets secondary hospitals with basic laboratory capacity in middle-income settings.
Methods: This was a retrospective study. 2,761 women diagnosed with hypertensive disorders of pregnancy formed the development set (training and internal validation sets), and 592 women from the same hospital constituted a temporal validation set to evaluate model performance. LASSO regression was applied for optimal feature selection, and the prediction model was constructed using multivariable logistic regression. Model performance was evaluated via the area under the receiver operating characteristic curve, calibration curves, decision curve analysis, and clinical impact curves.
Results: Key predictors, including placental abruption, placenta previa, placenta accreta, macrosomia, hemoglobin level, international normalized ratio, D-dimer concentration, and parity, were incorporated into a nomogram. The model achieved areas under the curve of 0.733 (training set), 0.756 (internal validation set), and 0.877 (temporal validation set). The apparent and bias-corrected calibration curves deviated from the ideal line at low predicted probabilities and gradually approached it as predicted PPH risk increased. Decision curve analysis indicated that the model yielded a higher net benefit compared with treat-all and treat-none strategies, whereas the clinical impact curve characterized the counts of predicted high-risk women and observed PPH events across risk thresholds.
Conclusion: The model demonstrated moderate discrimination and may be suitable for stratifying postpartum hemorrhage risk among women with hypertensive disorders of pregnancy.
Related
- Prevention and management of postpartum hemorrhage and hypertensive disorders of pregnancy: results from a 31-country rapid assessment
- Assessment of Persistent Postpartum Hypertension Following Hypertensive Disorders of Pregnancy: A Scoping Review
- Evaluation of a postpartum cardiovascular risk clinic after hypertensive disorder of pregnancy: First-year experience.
- Diet Quality and Physical Activity at 3-4 Years Following a Hypertensive Pregnancy: A Blood Pressure Postpartum Cross-Sectional Sub-Study.
- Prospective Longitudinal Assessment of Central Hemodynamic Profile in Normotensive, Hypertensive and Preeclamptic Women in Pregnancy and Postpartum
BibTeX
@article{yang2026novel,
title = {{A novel postpartum hemorrhage prediction model for women with hypertensive disorders of pregnancy in secondary hospitals of middle-income settings}},
author = {Mei Yang and Menghui Wang and Nanfang Li},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = nov,
doi = {10.3389/fcvm.2026.1889478},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1889478/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - A novel postpartum hemorrhage prediction model for women with hypertensive disorders of pregnancy in secondary hospitals of middle-income settings
AU - Mei Yang
AU - Menghui Wang
AU - Nanfang Li
PY - 2026
DA - 2026/11/04
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1889478
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1889478/full
AB - Background: This study aimed to develop and validate a risk-stratification tool to aid clinical referral decision-making for postpartum hemorrhage among women with hypertensive disorders of pregnancy. The tool targets secondary hospitals with basic laboratory capacity in middle-income settings. Methods: This was a retrospective study. 2,761 women diagnosed with hypertensive disorders of pregnancy formed the development set (training and internal validation sets), and 592 women from the same hospital constituted a temporal validation set to evaluate model performance. LASSO regression was applied for optimal feature selection, and the prediction model was constructed using multivariable logistic regression. Model performance was evaluated via the area under the receiver operating characteristic curve, calibration curves, decision curve analysis, and clinical impact curves. Results: Key predictors, including placental abruption, placenta previa, placenta accreta, macrosomia, hemoglobin level, international normalized ratio, D-dimer concentration, and parity, were incorporated into a nomogram. The model achieved areas under the curve of 0.733 (training set), 0.756 (internal validation set), and 0.877 (temporal validation set). The apparent and bias-corrected calibration curves deviated from the ideal line at low predicted probabilities and gradually approached it as predicted PPH risk increased. Decision curve analysis indicated that the model yielded a higher net benefit compared with treat-all and treat-none strategies, whereas the clinical impact curve characterized the counts of predicted high-risk women and observed PPH events across risk thresholds. Conclusion: The model demonstrated moderate discrimination and may be suitable for stratifying postpartum hemorrhage risk among women with hypertensive disorders of pregnancy.
SN - 2297-055X
ER -