Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis
- Autores
- Gallos, Ioannis; Williams, Caitlin R.; Price, Malcolm J.; Tobias, Aurelio; Devall, Adam; Allotey, John; Althabe, Fernando; Cresswell, Jenny A.; Durocher, Jill; Metin Gülmezoglu, A.; Haslinger, Christian; Pacagnella, Rodolfo C.; Sentilhes, Loïc; Sobhy, Soha; Yunas, Idnan; Deeks, Jonathan J.; Coomarasamy, Arri; Oladapo, Olufemi T.; Borovac Pinheiro, Anderson; Carroli, Guillermo; Coomarasamy, Arri; Durocher, Jill; Alwy Al Beity, Fadhlun M.; Fawcus, Sue; Festin, Mario; Galadanci, Hadiza S.; Goudar, Shivaprasad; Gülmezoglu, A. Metin; Haslinger, Christian; Hofmeyr, G. Justus
- Año de publicación
- 2025
- Idioma
- inglés
- Tipo de recurso
- artículo
- Estado
- versión publicada
- Descripción
- Background: Postpartum haemorrhage (excessive bleeding after birth) is a leading cause of maternal mortality and morbidity worldwide. However, there is no global consensus on which clinical markers best define excessive bleeding or reliably predict adverse maternal outcomes. The aim of this study was to assess the prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity.Methods: In this individual participant data meta-analysis, eligible datasets were identified through a global call for data issued by WHO and systematic searches of PubMed, MEDLINE, Embase, the Cochrane Library, and WHO trial registries (from database inception to Nov 6, 2024). Studies were eligible if they included at least 200 participants with objectively measured blood loss or other clinical markers of haemodynamic instability, and reported at least one clinical outcome of interest. Individual participant data were requested for all eligible studies. For each dataset, we computed the prognostic accuracy of each clinical marker to predict a composite outcome of maternal mortality or severe morbidity (blood transfusion, surgical interventions, or admission to intensive care unit). Five clinical markers were assessed: measured blood loss, pulse rate, systolic blood pressure, diastolic blood pressure, and shock index. Results were meta-analysed through two-level mixed-effects logistic regression models, with a bivariate normal model used to generate summary accuracy estimates. Clinical marker and threshold selections were informed by a WHO expert consensus process, which placed emphasis on maximising prognostic sensitivity (preferably >80%) over prognostic specificity (preferably ≥50%). This meta-analysis was registered on PROSPERO (CRD420251034918).Findings: We identified 33 potentially eligible datasets and successfully obtained and analysed full data for 12 datasets, comprising 312 151 women. At the conventional threshold of 500 mL, measured blood loss had a summary prognostic sensitivity of 75·7% (95% CI 60·3-86·4) and specificity of 81·4% (95% CI 70·7-88·8) for predicting the composite outcome. The preferred sensitivity threshold was reached at 300 mL (83·9% [95% CI 72·8-91·1]), although at the expense of reduced specificity (54·8% [95% CI 38·0-70·5]). Prognostic performance improved with a decision rule that combined the use of either blood loss thresholds less than 500 mL (≥300 mL to ≥450 mL) and any abnormal haemodynamic sign (pulse rate >100 beats per min, systolic blood pressure <100 mm Hg, diastolic blood pressure <60 mm Hg, or shock index >1·0) or 500 mL or more of blood loss, with sensitivities ranging from 86·9% to 87·9% and specificities from 66·6% to 76·1%.Interpretation: Measured blood loss below the conventional threshold, combined with abnormal haemodynamic signs, accurately predicts women at risk of death or life-threatening complications from postpartum bleeding and could support earlier postpartum haemorrhage diagnosis and treatment.
Fil: Gallos, Ioannis. Organizacion Mundial de la Salud; Argentina
Fil: Williams, Caitlin R.. Organizacion Mundial de la Salud; Argentina
Fil: Price, Malcolm J.. Canadian University Dubai; Emiratos Árabes Unidos
Fil: Tobias, Aurelio. Consejo Superior de Investigaciones Científicas; España
Fil: Devall, Adam. University Of Birmingham;
Fil: Allotey, John. University of Liverpool; Reino Unido
Fil: Althabe, Fernando. Organizacion Mundial de la Salud; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Cresswell, Jenny A.. Organizacion Mundial de la Salud; Argentina
Fil: Durocher, Jill. No especifíca;
Fil: Metin Gülmezoglu, A.. No especifíca;
Fil: Haslinger, Christian. Universitat Zurich; Suiza
Fil: Pacagnella, Rodolfo C.. Universidade Estadual de Campinas; Brasil
Fil: Sentilhes, Loïc. Bordeaux University Hospital; Francia
Fil: Sobhy, Soha. University Of Birmingham;
Fil: Yunas, Idnan. University Of Birmingham;
Fil: Deeks, Jonathan J.. University Of Birmingham;
Fil: Coomarasamy, Arri. University of Oxford; Reino Unido
Fil: Oladapo, Olufemi T.. Organizacion Mundial de la Salud; Argentina
Fil: Borovac Pinheiro, Anderson. Universidade Estadual de Campinas; Brasil
Fil: Carroli, Guillermo. Centro Rosarino de Estudios Perinatales; Argentina
Fil: Coomarasamy, Arri. University of Oxford; Reino Unido
Fil: Durocher, Jill. Gynuity Health Projects; Estados Unidos
Fil: Alwy Al Beity, Fadhlun M.. Muhimbili University Of Health And Allied Sciences; Tanzania
Fil: Fawcus, Sue. University of Cape Town; Sudáfrica
Fil: Festin, Mario. University Of The Philippines; Filipinas
Fil: Galadanci, Hadiza S.. Bayero University; Nigeria
Fil: Goudar, Shivaprasad. Kle Academy Of Higher Education And Research; India
Fil: Gülmezoglu, A. Metin. No especifíca;
Fil: Haslinger, Christian. University Of Zurich; Suiza
Fil: Hofmeyr, G. Justus. Walter Sisulu University; Sudáfrica - Materia
-
POSTPARTUM HAEMORRHAGE
MATERNAL MORTALITY
SEVERE MATERNAL MORBIDITY
PROGNOSTIC MARKERS - Nivel de accesibilidad
- acceso abierto
- Condiciones de uso
- https://creativecommons.org/licenses/by/2.5/ar/
- Repositorio
.jpg)
- Institución
- Consejo Nacional de Investigaciones Científicas y Técnicas
- OAI Identificador
- oai:ri.conicet.gov.ar:11336/292511
Ver los metadatos del registro completo
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Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysisGallos, IoannisWilliams, Caitlin R.Price, Malcolm J.Tobias, AurelioDevall, AdamAllotey, JohnAlthabe, FernandoCresswell, Jenny A.Durocher, JillMetin Gülmezoglu, A.Haslinger, ChristianPacagnella, Rodolfo C.Sentilhes, LoïcSobhy, SohaYunas, IdnanDeeks, Jonathan J.Coomarasamy, ArriOladapo, Olufemi T.Borovac Pinheiro, AndersonCarroli, GuillermoCoomarasamy, ArriDurocher, JillAlwy Al Beity, Fadhlun M.Fawcus, SueFestin, MarioGaladanci, Hadiza S.Goudar, ShivaprasadGülmezoglu, A. MetinHaslinger, ChristianHofmeyr, G. JustusPOSTPARTUM HAEMORRHAGEMATERNAL MORTALITYSEVERE MATERNAL MORBIDITYPROGNOSTIC MARKERShttps://purl.org/becyt/ford/3.3https://purl.org/becyt/ford/3Background: Postpartum haemorrhage (excessive bleeding after birth) is a leading cause of maternal mortality and morbidity worldwide. However, there is no global consensus on which clinical markers best define excessive bleeding or reliably predict adverse maternal outcomes. The aim of this study was to assess the prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity.Methods: In this individual participant data meta-analysis, eligible datasets were identified through a global call for data issued by WHO and systematic searches of PubMed, MEDLINE, Embase, the Cochrane Library, and WHO trial registries (from database inception to Nov 6, 2024). Studies were eligible if they included at least 200 participants with objectively measured blood loss or other clinical markers of haemodynamic instability, and reported at least one clinical outcome of interest. Individual participant data were requested for all eligible studies. For each dataset, we computed the prognostic accuracy of each clinical marker to predict a composite outcome of maternal mortality or severe morbidity (blood transfusion, surgical interventions, or admission to intensive care unit). Five clinical markers were assessed: measured blood loss, pulse rate, systolic blood pressure, diastolic blood pressure, and shock index. Results were meta-analysed through two-level mixed-effects logistic regression models, with a bivariate normal model used to generate summary accuracy estimates. Clinical marker and threshold selections were informed by a WHO expert consensus process, which placed emphasis on maximising prognostic sensitivity (preferably >80%) over prognostic specificity (preferably ≥50%). This meta-analysis was registered on PROSPERO (CRD420251034918).Findings: We identified 33 potentially eligible datasets and successfully obtained and analysed full data for 12 datasets, comprising 312 151 women. At the conventional threshold of 500 mL, measured blood loss had a summary prognostic sensitivity of 75·7% (95% CI 60·3-86·4) and specificity of 81·4% (95% CI 70·7-88·8) for predicting the composite outcome. The preferred sensitivity threshold was reached at 300 mL (83·9% [95% CI 72·8-91·1]), although at the expense of reduced specificity (54·8% [95% CI 38·0-70·5]). Prognostic performance improved with a decision rule that combined the use of either blood loss thresholds less than 500 mL (≥300 mL to ≥450 mL) and any abnormal haemodynamic sign (pulse rate >100 beats per min, systolic blood pressure <100 mm Hg, diastolic blood pressure <60 mm Hg, or shock index >1·0) or 500 mL or more of blood loss, with sensitivities ranging from 86·9% to 87·9% and specificities from 66·6% to 76·1%.Interpretation: Measured blood loss below the conventional threshold, combined with abnormal haemodynamic signs, accurately predicts women at risk of death or life-threatening complications from postpartum bleeding and could support earlier postpartum haemorrhage diagnosis and treatment.Fil: Gallos, Ioannis. Organizacion Mundial de la Salud; ArgentinaFil: Williams, Caitlin R.. Organizacion Mundial de la Salud; ArgentinaFil: Price, Malcolm J.. Canadian University Dubai; Emiratos Árabes UnidosFil: Tobias, Aurelio. Consejo Superior de Investigaciones Científicas; EspañaFil: Devall, Adam. University Of Birmingham;Fil: Allotey, John. University of Liverpool; Reino UnidoFil: Althabe, Fernando. Organizacion Mundial de la Salud; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Cresswell, Jenny A.. Organizacion Mundial de la Salud; ArgentinaFil: Durocher, Jill. No especifíca;Fil: Metin Gülmezoglu, A.. No especifíca;Fil: Haslinger, Christian. Universitat Zurich; SuizaFil: Pacagnella, Rodolfo C.. Universidade Estadual de Campinas; BrasilFil: Sentilhes, Loïc. Bordeaux University Hospital; FranciaFil: Sobhy, Soha. University Of Birmingham;Fil: Yunas, Idnan. University Of Birmingham;Fil: Deeks, Jonathan J.. University Of Birmingham;Fil: Coomarasamy, Arri. University of Oxford; Reino UnidoFil: Oladapo, Olufemi T.. Organizacion Mundial de la Salud; ArgentinaFil: Borovac Pinheiro, Anderson. Universidade Estadual de Campinas; BrasilFil: Carroli, Guillermo. Centro Rosarino de Estudios Perinatales; ArgentinaFil: Coomarasamy, Arri. University of Oxford; Reino UnidoFil: Durocher, Jill. Gynuity Health Projects; Estados UnidosFil: Alwy Al Beity, Fadhlun M.. Muhimbili University Of Health And Allied Sciences; TanzaniaFil: Fawcus, Sue. University of Cape Town; SudáfricaFil: Festin, Mario. University Of The Philippines; FilipinasFil: Galadanci, Hadiza S.. Bayero University; NigeriaFil: Goudar, Shivaprasad. Kle Academy Of Higher Education And Research; IndiaFil: Gülmezoglu, A. Metin. No especifíca;Fil: Haslinger, Christian. University Of Zurich; SuizaFil: Hofmeyr, G. Justus. Walter Sisulu University; SudáfricaElsevier Science Inc.2025-10info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/292511Gallos, Ioannis; Williams, Caitlin R.; Price, Malcolm J.; Tobias, Aurelio; Devall, Adam; et al.; Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis; Elsevier Science Inc.; Lancet; 406; 10514; 10-2025; 1969-19820140-6736CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://linkinghub.elsevier.com/retrieve/pii/S0140673625016393info:eu-repo/semantics/altIdentifier/doi/10.1016/S0140-6736(25)01639-3info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2026-08-25T14:30:31Zoai:ri.conicet.gov.ar:11336/292511instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982026-08-25 14:30:31.78CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse |
| dc.title.none.fl_str_mv |
Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis |
| title |
Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis |
| spellingShingle |
Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis Gallos, Ioannis POSTPARTUM HAEMORRHAGE MATERNAL MORTALITY SEVERE MATERNAL MORBIDITY PROGNOSTIC MARKERS |
| title_short |
Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis |
| title_full |
Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis |
| title_fullStr |
Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis |
| title_full_unstemmed |
Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis |
| title_sort |
Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis |
| dc.creator.none.fl_str_mv |
Gallos, Ioannis Williams, Caitlin R. Price, Malcolm J. Tobias, Aurelio Devall, Adam Allotey, John Althabe, Fernando Cresswell, Jenny A. Durocher, Jill Metin Gülmezoglu, A. Haslinger, Christian Pacagnella, Rodolfo C. Sentilhes, Loïc Sobhy, Soha Yunas, Idnan Deeks, Jonathan J. Coomarasamy, Arri Oladapo, Olufemi T. Borovac Pinheiro, Anderson Carroli, Guillermo Coomarasamy, Arri Durocher, Jill Alwy Al Beity, Fadhlun M. Fawcus, Sue Festin, Mario Galadanci, Hadiza S. Goudar, Shivaprasad Gülmezoglu, A. Metin Haslinger, Christian Hofmeyr, G. Justus |
| author |
Gallos, Ioannis |
| author_facet |
Gallos, Ioannis Williams, Caitlin R. Price, Malcolm J. Tobias, Aurelio Devall, Adam Allotey, John Althabe, Fernando Cresswell, Jenny A. Durocher, Jill Metin Gülmezoglu, A. Haslinger, Christian Pacagnella, Rodolfo C. Sentilhes, Loïc Sobhy, Soha Yunas, Idnan Deeks, Jonathan J. Coomarasamy, Arri Oladapo, Olufemi T. Borovac Pinheiro, Anderson Carroli, Guillermo Alwy Al Beity, Fadhlun M. Fawcus, Sue Festin, Mario Galadanci, Hadiza S. Goudar, Shivaprasad Gülmezoglu, A. Metin Hofmeyr, G. Justus |
| author_role |
author |
| author2 |
Williams, Caitlin R. Price, Malcolm J. Tobias, Aurelio Devall, Adam Allotey, John Althabe, Fernando Cresswell, Jenny A. Durocher, Jill Metin Gülmezoglu, A. Haslinger, Christian Pacagnella, Rodolfo C. Sentilhes, Loïc Sobhy, Soha Yunas, Idnan Deeks, Jonathan J. Coomarasamy, Arri Oladapo, Olufemi T. Borovac Pinheiro, Anderson Carroli, Guillermo Alwy Al Beity, Fadhlun M. Fawcus, Sue Festin, Mario Galadanci, Hadiza S. Goudar, Shivaprasad Gülmezoglu, A. Metin Hofmeyr, G. Justus |
| author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author |
| dc.subject.none.fl_str_mv |
POSTPARTUM HAEMORRHAGE MATERNAL MORTALITY SEVERE MATERNAL MORBIDITY PROGNOSTIC MARKERS |
| topic |
POSTPARTUM HAEMORRHAGE MATERNAL MORTALITY SEVERE MATERNAL MORBIDITY PROGNOSTIC MARKERS |
| purl_subject.fl_str_mv |
https://purl.org/becyt/ford/3.3 https://purl.org/becyt/ford/3 |
| dc.description.none.fl_txt_mv |
Background: Postpartum haemorrhage (excessive bleeding after birth) is a leading cause of maternal mortality and morbidity worldwide. However, there is no global consensus on which clinical markers best define excessive bleeding or reliably predict adverse maternal outcomes. The aim of this study was to assess the prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity.Methods: In this individual participant data meta-analysis, eligible datasets were identified through a global call for data issued by WHO and systematic searches of PubMed, MEDLINE, Embase, the Cochrane Library, and WHO trial registries (from database inception to Nov 6, 2024). Studies were eligible if they included at least 200 participants with objectively measured blood loss or other clinical markers of haemodynamic instability, and reported at least one clinical outcome of interest. Individual participant data were requested for all eligible studies. For each dataset, we computed the prognostic accuracy of each clinical marker to predict a composite outcome of maternal mortality or severe morbidity (blood transfusion, surgical interventions, or admission to intensive care unit). Five clinical markers were assessed: measured blood loss, pulse rate, systolic blood pressure, diastolic blood pressure, and shock index. Results were meta-analysed through two-level mixed-effects logistic regression models, with a bivariate normal model used to generate summary accuracy estimates. Clinical marker and threshold selections were informed by a WHO expert consensus process, which placed emphasis on maximising prognostic sensitivity (preferably >80%) over prognostic specificity (preferably ≥50%). This meta-analysis was registered on PROSPERO (CRD420251034918).Findings: We identified 33 potentially eligible datasets and successfully obtained and analysed full data for 12 datasets, comprising 312 151 women. At the conventional threshold of 500 mL, measured blood loss had a summary prognostic sensitivity of 75·7% (95% CI 60·3-86·4) and specificity of 81·4% (95% CI 70·7-88·8) for predicting the composite outcome. The preferred sensitivity threshold was reached at 300 mL (83·9% [95% CI 72·8-91·1]), although at the expense of reduced specificity (54·8% [95% CI 38·0-70·5]). Prognostic performance improved with a decision rule that combined the use of either blood loss thresholds less than 500 mL (≥300 mL to ≥450 mL) and any abnormal haemodynamic sign (pulse rate >100 beats per min, systolic blood pressure <100 mm Hg, diastolic blood pressure <60 mm Hg, or shock index >1·0) or 500 mL or more of blood loss, with sensitivities ranging from 86·9% to 87·9% and specificities from 66·6% to 76·1%.Interpretation: Measured blood loss below the conventional threshold, combined with abnormal haemodynamic signs, accurately predicts women at risk of death or life-threatening complications from postpartum bleeding and could support earlier postpartum haemorrhage diagnosis and treatment. Fil: Gallos, Ioannis. Organizacion Mundial de la Salud; Argentina Fil: Williams, Caitlin R.. Organizacion Mundial de la Salud; Argentina Fil: Price, Malcolm J.. Canadian University Dubai; Emiratos Árabes Unidos Fil: Tobias, Aurelio. Consejo Superior de Investigaciones Científicas; España Fil: Devall, Adam. University Of Birmingham; Fil: Allotey, John. University of Liverpool; Reino Unido Fil: Althabe, Fernando. Organizacion Mundial de la Salud; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Cresswell, Jenny A.. Organizacion Mundial de la Salud; Argentina Fil: Durocher, Jill. No especifíca; Fil: Metin Gülmezoglu, A.. No especifíca; Fil: Haslinger, Christian. Universitat Zurich; Suiza Fil: Pacagnella, Rodolfo C.. Universidade Estadual de Campinas; Brasil Fil: Sentilhes, Loïc. Bordeaux University Hospital; Francia Fil: Sobhy, Soha. University Of Birmingham; Fil: Yunas, Idnan. University Of Birmingham; Fil: Deeks, Jonathan J.. University Of Birmingham; Fil: Coomarasamy, Arri. University of Oxford; Reino Unido Fil: Oladapo, Olufemi T.. Organizacion Mundial de la Salud; Argentina Fil: Borovac Pinheiro, Anderson. Universidade Estadual de Campinas; Brasil Fil: Carroli, Guillermo. Centro Rosarino de Estudios Perinatales; Argentina Fil: Coomarasamy, Arri. University of Oxford; Reino Unido Fil: Durocher, Jill. Gynuity Health Projects; Estados Unidos Fil: Alwy Al Beity, Fadhlun M.. Muhimbili University Of Health And Allied Sciences; Tanzania Fil: Fawcus, Sue. University of Cape Town; Sudáfrica Fil: Festin, Mario. University Of The Philippines; Filipinas Fil: Galadanci, Hadiza S.. Bayero University; Nigeria Fil: Goudar, Shivaprasad. Kle Academy Of Higher Education And Research; India Fil: Gülmezoglu, A. Metin. No especifíca; Fil: Haslinger, Christian. University Of Zurich; Suiza Fil: Hofmeyr, G. Justus. Walter Sisulu University; Sudáfrica |
| description |
Background: Postpartum haemorrhage (excessive bleeding after birth) is a leading cause of maternal mortality and morbidity worldwide. However, there is no global consensus on which clinical markers best define excessive bleeding or reliably predict adverse maternal outcomes. The aim of this study was to assess the prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity.Methods: In this individual participant data meta-analysis, eligible datasets were identified through a global call for data issued by WHO and systematic searches of PubMed, MEDLINE, Embase, the Cochrane Library, and WHO trial registries (from database inception to Nov 6, 2024). Studies were eligible if they included at least 200 participants with objectively measured blood loss or other clinical markers of haemodynamic instability, and reported at least one clinical outcome of interest. Individual participant data were requested for all eligible studies. For each dataset, we computed the prognostic accuracy of each clinical marker to predict a composite outcome of maternal mortality or severe morbidity (blood transfusion, surgical interventions, or admission to intensive care unit). Five clinical markers were assessed: measured blood loss, pulse rate, systolic blood pressure, diastolic blood pressure, and shock index. Results were meta-analysed through two-level mixed-effects logistic regression models, with a bivariate normal model used to generate summary accuracy estimates. Clinical marker and threshold selections were informed by a WHO expert consensus process, which placed emphasis on maximising prognostic sensitivity (preferably >80%) over prognostic specificity (preferably ≥50%). This meta-analysis was registered on PROSPERO (CRD420251034918).Findings: We identified 33 potentially eligible datasets and successfully obtained and analysed full data for 12 datasets, comprising 312 151 women. At the conventional threshold of 500 mL, measured blood loss had a summary prognostic sensitivity of 75·7% (95% CI 60·3-86·4) and specificity of 81·4% (95% CI 70·7-88·8) for predicting the composite outcome. The preferred sensitivity threshold was reached at 300 mL (83·9% [95% CI 72·8-91·1]), although at the expense of reduced specificity (54·8% [95% CI 38·0-70·5]). Prognostic performance improved with a decision rule that combined the use of either blood loss thresholds less than 500 mL (≥300 mL to ≥450 mL) and any abnormal haemodynamic sign (pulse rate >100 beats per min, systolic blood pressure <100 mm Hg, diastolic blood pressure <60 mm Hg, or shock index >1·0) or 500 mL or more of blood loss, with sensitivities ranging from 86·9% to 87·9% and specificities from 66·6% to 76·1%.Interpretation: Measured blood loss below the conventional threshold, combined with abnormal haemodynamic signs, accurately predicts women at risk of death or life-threatening complications from postpartum bleeding and could support earlier postpartum haemorrhage diagnosis and treatment. |
| publishDate |
2025 |
| dc.date.none.fl_str_mv |
2025-10 |
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info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion http://purl.org/coar/resource_type/c_6501 info:ar-repo/semantics/articulo |
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article |
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http://hdl.handle.net/11336/292511 Gallos, Ioannis; Williams, Caitlin R.; Price, Malcolm J.; Tobias, Aurelio; Devall, Adam; et al.; Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis; Elsevier Science Inc.; Lancet; 406; 10514; 10-2025; 1969-1982 0140-6736 CONICET Digital CONICET |
| url |
http://hdl.handle.net/11336/292511 |
| identifier_str_mv |
Gallos, Ioannis; Williams, Caitlin R.; Price, Malcolm J.; Tobias, Aurelio; Devall, Adam; et al.; Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis; Elsevier Science Inc.; Lancet; 406; 10514; 10-2025; 1969-1982 0140-6736 CONICET Digital CONICET |
| dc.language.none.fl_str_mv |
eng |
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eng |
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info:eu-repo/semantics/altIdentifier/url/https://linkinghub.elsevier.com/retrieve/pii/S0140673625016393 info:eu-repo/semantics/altIdentifier/doi/10.1016/S0140-6736(25)01639-3 |
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info:eu-repo/semantics/openAccess https://creativecommons.org/licenses/by/2.5/ar/ |
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openAccess |
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https://creativecommons.org/licenses/by/2.5/ar/ |
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application/pdf application/pdf |
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Elsevier Science Inc. |
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Elsevier Science Inc. |
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reponame:CONICET Digital (CONICET) instname:Consejo Nacional de Investigaciones Científicas y Técnicas |
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CONICET Digital (CONICET) |
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Consejo Nacional de Investigaciones Científicas y Técnicas |
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CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas |
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dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar |
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