Abstract
Background: Postpartum Haemorrhage (PPH) remains a leading cause of
maternal mortality and morbidity worldwide, and the rate is increasing.
Using a reliable predictive model could identify those at risk, support
management and treatment, and improve maternal outcomes. Objectives: To
systematically identify and appraise existing prognostic models for PPH
and ascertain suitability for clinical use. Search strategy: MEDLINE,
CINAHL, Embase, and the Cochrane Library were searched using
combinations of terms and synonyms including ‘postpartum haemorrhage’,
‘prognostic model’, and ‘risk factors’ that were developed from a
scoping review. Selection Criteria: Observational or experimental
studies describing a prognostic model for risk of PPH, published in
English. Data Collection and Analysis: The Critical Appraisal and Data
Extraction for Systematic Reviews of Prediction Modelling Studies
checklist informed data extraction and Prediction Model Risk of Bias
Assessment Tool guided analysis. Main Results: 16 studies met the
inclusion criteria after screening 1612 records. All studies were
hospital settings from 8 different countries. Models were developed for
women who experienced vaginal birth (n=7), caesarean birth(n=2), any
type of birth(n=2), hypertensive disorders(n=1) and those with placental
abnormalities(n=4). All studies were at high risk of bias due to use of
inappropriate analysis methods or omission of important statistical
considerations or suboptimal validation. Conclusions: No existing
prognostic models for PPH are ready for clinical application. Future
research is needed to externally validate existing models and
potentially develop a new model that is reliable and applicable to
clinical practice. Funding: This study received no funding. Keywords:
Postpartum haemorrhage, prognostic model, prediction tool.