Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis
Authors' conclusion
Measured blood loss below the conventional threshold, combined with abnormal haemodynamic signs, accurately predicts women at risk of death or life-threatening complications from postpartum bleeding
Study context
- Population
- Women after birth in datasets with ≥200 participants with objectively measured blood loss or other clinical markers of haemodynamic instability12 datasets
- Participants
- 312,151 women
- Comparison
- Clinical markers of postpartum bleeding (measured blood loss thresholds, haemodynamic signs, combined decision rule) for predicting maternal mortality or severe morbidity
- Outcome
- Composite of:
- Maternal mortality
- Severe morbidity (blood transfusion, surgical interventions, or ICU admission)
Methodological detailsprognostic accuracy, WHO global call for data and systematic searches, two-level mixed-effects logistic regression, bivariate normal model, 33 potentially eligible datasets identified; full data obtained and analysed for 12
- Prognostic accuracy
- WHO global call for data and systematic searches
- Two-level mixed-effects logistic regression
- Bivariate normal model
- 33 potentially eligible datasets identified; full data obtained and analysed for 12
Pooled result
As reported in the abstract
Prognostic accuracy for the composite outcome
| Strategy | Sensitivity | Specificity |
|---|---|---|
| Blood loss ≥500 mL | 75.7% (95% CI 60.3-86.4)Sensitivity on a scale from 0 to 100 percent | 81.4% (95% CI 70.7-88.8)Specificity on a scale from 0 to 100 percent |
| Blood loss ≥300 mL | 83.9% (95% CI 72.8-91.1)Sensitivity on a scale from 0 to 100 percent | 54.8% (95% CI 38.0-70.5)Specificity on a scale from 0 to 100 percent |
| Combined decision rule | 86.9% to 87.9% | 66.6% to 76.1% |
Sensitivity
Blood loss ≥500 mL75.7% (95% CI 60.3-86.4)
Blood loss ≥300 mL83.9% (95% CI 72.8-91.1)
Combined decision rule86.9% to 87.9%
Sensitivity on a scale from 0 to 100 percentSpecificity
Blood loss ≥500 mL81.4% (95% CI 70.7-88.8)
Blood loss ≥300 mL54.8% (95% CI 38.0-70.5)
Combined decision rule66.6% to 76.1%
Specificity on a scale from 0 to 100 percentOriginal publication
Prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity: a WHO individual participant data meta-analysis. Lancet. Published 4 October 2025. doi:10.
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