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Prediction of escape red blood cell transfusion in expectantly managed women with acute anaemia after postpartum haemorrhage
Author(s) -
Prick BW,
Schuit E,
Mignini L,
Jansen AJG,
Rhenen DJ,
Steegers EAP,
Mol BW,
Duvekot JJ
Publication year - 2015
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.13224
Subject(s) - medicine , obstetrics , blood transfusion , pregnancy , population , surgery , genetics , environmental health , biology
Objective To determine clinical predictors of escape red blood cell ( RBC ) transfusion in postpartum anaemic women, initially managed expectantly, and the additional predictive value of health‐related quality of life ( HRQ o L ) measures. Design Secondary analysis of women after postpartum haemorrhage, either randomly allocated to, or opting for expectant management. Setting Thirty‐seven hospitals in the N etherlands. Population A total of 261 randomised and 362 nonrandomised women. Methods We developed prediction models to assess the need for RBC transfusion: one using clinical variables (model 1), and one extended with scores on the HRQ oL‐measures M ultidimensional F atigue I nventory ( MFI ) and E uro Q ol‐5 D (model 2). Model performance was assessed by discrimination and calibration. Models were internally validated with bootstrapping techniques to correct for overfitting. Main outcome measures Escape RBC transfusion. Results Seventy‐five women (12%) received escape RBC transfusion. Independent predictors of escape RBC transfusion (model 1) were primiparity, multiple pregnancy, total blood loss during delivery and haemoglobin concentration postpartum. Maternal age, body mass index, ethnicity, education, medical indication of pregnancy, mode of delivery, preterm delivery, placental removal, perineal laceration, A pgar score and breastfeeding intention had no predictive value. Addition of HRQ oL‐scores (model 2), significantly improved the model's discriminative ability: c ‐statistics of model 1 and 2 were 0.65 (95% CI 0.58–0.72) and 0.72 (95% CI 0.65–0.79), respectively. The calibration of both models was good. Conclusions In postpartum anaemic women, several clinical variables predict the need for escape RBC transfusion. Adding HRQ oL‐scores improves model performance. After external validation, the extended model may be an important tool for counselling and decision making in clinical practice.