Objective To evaluate whether the concentration of serum lactate during the diagnosis of postpartum hemorrhage (bleeding ≥500 mL during labor or ≥1000 mL during cesarean delivery) predicts severe hemorrhage (SPPH; blood loss ≥1500 mL at end of labor or in the following 24 h). Methods A prospective cohort pilot study was conducted of women with a vaginal or cesarean delivery from February 2018 to March 2019 who presented with bleeding ≥500 mL measured by the gravimetric method in a reference hospital in San Luis Potosi, Mexico. Venous blood samples were taken for analysis of serum lactate. A receiver operating characteristic curve determined the serum lactate threshold value for SPPH and χ2 test assessed the difference in serum lactate elevation between SPPH and non‐SPPH groups. Lastly, the prognostic capacity between the thresholds was compared. Results SPPH developed in 43.33% of the 30 women in the study group. The best prognostic threshold was 2.68 mmol/L of serum lactate (odds ratio [OR] 17.88, 95% confidence interval [CI] 2.7–16.8, P < 0.001); sensitivity was 0.85 (95% CI 0.55–0.98); specificity was 0.76 (95% CI 0.50–0.93). Conclusion Serum lactate may be a useful prognostic marker for SPPH, more studies are needed to validate these findings.
characteristics, except for deliveries with postpartum anemia. The sensitivity of the codes for PPH with postpartum anemia was higher than those for PPH without this diagnosis [94.2% (95% CI: 93.9-94.5) vs. 82.6% (95% CI: 82.1-83.1)]; the specificity for PPH with postpartum anemia was lower than those without this diagnosis [93.0% (95% CI: 92.7-93.3) vs. 99.7% (95% CI: 99.7-99.7)]. The sensitivity of ICD-10 codes for PPH with ≥ 1 unit of transfusion was 91.3% (95% CI: 90.7-91.9), compared with the sensitivity for PPH without transfusion [88.0% (95% CI: 87.6-88.4)]. The specificity of ICD codes for PPH with ≥ 1 unit of transfusion was 83.5% (95% CI: 82.3-84.6) versus the specificity for PPH without transfusion of 99.6% (95% CI: 99.6-99.6). The sensitivity and specificity for PPH with ≥ 4 units of blood transfusion was 90.3% (95% CI: 88.9-91.6) and 73.6% (95% CI: 69.8-77.1), respectively.These findings suggest that the ICD-10 codes for PPH have high sensitivity and specificity. Ensuring the accuracy of the diagnostic codes for PPH are useful for research purposes, quality improvement efforts, and reporting PPH trends.
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