Prediction of postpartum hemorrhage in pregnant women with immune thrombocytopenia: Development and validation of the <scp>MONITOR</scp> model in a nationwide multicenter study

Globally, postpartum hemorrhage (PPH) is the leading cause of maternal death. Women with immune thrombocytopenia (ITP) are at increased risk developing PPH. Early identification PPH helps to prevent adverse outcomes, but underused because clinicians do not have a tool predict for women ITP. We therefore conducted nationwide multicenter retrospective study develop and validate prediction model in patients included 432 pregnant (677 pregnancies) primary ITP from 18 academic tertiary centers China January 2008 August 2018. A total 157 (23.2%) pregnancies experienced The derivation cohort 450 pregnancies. For validation cohort, we 117 temporal 110 geographical cohort. assessed 25 clinical parameters as candidate predictors used multivariable logistic regression our model. final seven variables was named MONITOR (maternal complication, WHO bleeding score, antepartum platelet transfusion, placental abnormalities, count, previous uterine surgery, primiparity). established an easy-to-use heatmap score based on factors. externally validated this using both had AUC 0.868 (95% CI 0.828–0.909) internal validation, 0.869 0.802–0.937) 0.811 0.713–0.908) validation. Calibration plots demonstrated good agreement between MONITOR-predicted probability actual observation external Therefore, developed very accurate hope that will contribute more precise care, decreased better health care resource allocation.