Researchers recently developed a model to predict the risk of developing postpartum hemorrhage (PPH) in pregnant women with immune thrombocytopenia (ITP). Details were published in a paper in the American Journal of Hematology.

The research team explained in their report that, worldwide, PPH is the leading cause of maternal death and that ITP is a predisposing factor for PPH. However, they noted that fatalities associated with PPH may be limited with timely intervention.

In a multicenter, retrospective analysis, the researchers included data for pregnant women with primary ITP who were treated at 18 tertiary care centers throughout China. A total of 25 clinical parameters were evaluated in univariable analysis to identify possible predictors of PPH. Those who showed a relationship to PPH at a significance of P <.1 were included in a multivariable logistic regression analysis. Temporal and geographic cohorts were used for validation.

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A total of 677 pregnancies from 432 pregnant women were evaluated, with 450 pregnancies included in a derivation cohort, 117 included in a temporal validation cohort, and the remaining 110 included in a geographic cohort. PPH occurred with 23.2% of all pregnancies in this study.

A final model based on 7 variables was developed, which was named the “MONITOR” model. The variables included in this model were placental abnormalities, previous uterine surgery, primiparity, World Health Organization bleeding score, antepartum platelet transfusion, maternal complication, and platelet count.

In receiver operating characteristic curve analysis, the area under the curve (AUC) for this model in internal validation was 0.868 (95% CI, 0.828-0.909). In external validation, the model showed an AUC of 0.869 (95% CI, 0.802-0.937) for the temporal validation cohort, and an AUC of 0.811 (95% CI, 0.713-0.908) for the geographic validation cohort. The researchers reported that calibration plots for both internal and external validation analyses showed a high degree of concordance between observations and probabilities predicted by the MONITOR model.

“In summary, we have developed and validated a highly discriminating, well-calibrated, and parsimonious prediction model, the MONITOR, to predict the risk of PPH in pregnant women with ITP,” the researchers wrote in their report. They also indicated that the potential for early diagnosis enabled by the model may contribute to better clinical outcomes.


Huang QS, Zhu XL, Qu QY, et al. Prediction of postpartum hemorrhage in pregnant women with immune thrombocytopenia: development and validation of the MONITOR model in a nationwide multicenter study. Am J Hematol. Accepted manuscript. Published online February 19, 2021. doi:10.1002/ajh.26134