Deleu Florian, Nebout Sophie, Peynaud-Debayle Edith, Mandelbrot Laurent, Keita Hawa
Department of Anesthesia and Critical Care, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France.
Department of Anesthesia, Maussins-Nollet Private Hospital, Ramsay Santé, Paris, France.
BMC Pregnancy Childbirth. 2025 Feb 14;25(1):165. doi: 10.1186/s12884-025-07281-0.
Postpartum hemorrhage (PPH) is a common yet potentially serious complication of delivery. Recently, the HEMSTOP bleeding score has emerged as a tool for detecting preoperative inherited bleeding disorders. Our objective is to investigate its relevance within the obstetrical context for predicting PPH occurrences among unselected pregnant women.
Prospective cohort study conducted in a tertiary maternity hospital between 2014 and 2016 including women without any known bleeding disorder nor antithrombotic therapy who completed the HEMSTOP questionnaire before delivery. Primary outcome was primary PPH ≥ 500 mL following delivery. We studied the bleeding score ranging from zero to seven both as a continuous and an ordinal variable. We used multivariable analysis with adjustment on PPH risk factors. We also estimated the measures of the bleeding score prognostic accuracy.
PPH occurred in 116 of 2536 women (4.6%). Elevated bleeding scores were associated with increased PPH risk (adjusted RR = 1.58; 95% CI, 1.23 to 2.02; P < 0.001 for a continuous score) demonstrating a progressive rise in risk alongside score escalation (adjusted RR = 1.58; 95% CI, 1.01 to 2.46 for a score of one, adjusted RR = 2.11, 95% CI 0.86 to 5.20 for a score of two and adjusted RR = 7.20, 95% CI 2.54 to 20.41 for a score of three compared with a score of zero; P < 0.001). The area under the curve for the bleeding score accuracy in predicting PPH was 0.56 [95% CI 0.52 to 0.61].
The HEMSTOP bleeding score is weakly predictive of PPH. Women scoring ≥ three are at high risk of PPH.
产后出血（PPH）是一种常见但可能严重的分娩并发症。最近，HEMSTOP出血评分已成为检测术前遗传性出血性疾病的一种工具。我们的目的是研究其在产科背景下对预测未选择的孕妇发生PPH的相关性。
2014年至2016年在一家三级妇产医院进行的前瞻性队列研究，纳入了无任何已知出血性疾病且未接受抗血栓治疗的孕妇，这些孕妇在分娩前完成了HEMSTOP问卷。主要结局是分娩后原发性PPH≥500 mL。我们将出血评分从0到7作为连续变量和有序变量进行研究。我们使用多变量分析并对PPH危险因素进行调整。我们还估计了出血评分预后准确性的指标。
2536名女性中有116名发生PPH（4.6%）。出血评分升高与PPH风险增加相关（调整后的RR = 1.58；95% CI，1.23至2.02；连续评分P < 0.001），表明随着评分升高风险逐渐增加（评分为1时调整后的RR = 1.58；95% CI，1.01至2.46，评分为2时调整后的RR = 2.11，95% CI 0.86至5.20，评分为3时调整后的RR = 7.20，95% CI 2.54至20.41，与评分为0相比；P < 0.001）。出血评分预测PPH准确性的曲线下面积为0.56 [95% CI 0.52至0.61]。
HEMSTOP出血评分对PPH的预测能力较弱。评分≥3的女性发生PPH的风险较高。
