Amer J Perinatol 2018; 35(02): 163-169
DOI: 10.1055/s-0037-1606332
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Predicting Postpartum Hemorrhage (PPH) during Cesarean Delivery Using the Leicester PPH Predict Tool: A Retrospective Cohort Study

Suzanna E. Dunkerton1, Yadava B. Jeve1, Neil Walkinshaw2, Eamonn Breslin1, Tanu Singhal1
  • 1Department of Obstetrics and Gynecology, University Hospitals of Leicester, Leicester, United Kingdom
  • 2Department of Informatics, University of Leicester, Leicester, United Kingdom
Further Information

Publication History

06 July 2017

21 July 2017

Publication Date:
28 August 2017 (eFirst)


Objective The aim of the present study was to develop a toolkit combining various risk factors to predict the risk of developing a postpartum hemorrhage (PPH) during a cesarean delivery.

Study Design A retrospective cohort study of 24,230 women who had cesarean delivery between January 2003 and December 2013 at a tertiary care teaching hospital within the United Kingdom serving a multiethnic population. Data were extracted from hospital databases, and risk factors for PPH were identified. Hothorn et al recursive partitioning algorithm was used to infer a conditional decision tree. For each of the identified combinations of risk factors, two probabilities were calculated: the probability of a patient producing ≥1,000 and ≥ 2,000 mL blood loss.

Results The Leicester PPH predict score was then tested on the randomly selected remaining 25% (n = 6,095) of the data for internal validity. Reliability testing showed an intraclass correlation of 0.98 and mean absolute error of 239.8 mL with the actual outcome.

Conclusion The proposed toolkit enables clinicians to predict the risk of postpartum hemorrhage. As a result, preventative measures for postpartum hemorrhage could be undertaken. Further external validation of the current toolkit is required.


Retrospective service evaluation review was undertaken to analyze the complications of cesarean sections. Therefore, as per local protocol, ethical approval and individual subject consent were not required to analyze anonymized hospital data.

Authors' Contribution

S.E.D.: analysis and write up of article; Y.B.J.: idea conception and write up of article; E.B.: study design and data interpretation; N.W.: data analysis; T.S.: study design.