Uterine Tone Numeric Rating Score as an Early Indicator of Major Postpartum Hemorrhage during Cesarean Delivery: A Prospective Observational Study
Authors' conclusion
Standardized uterine tone assessments on a 0 to 10 scale are feasible to implement and strongly associated with progression to major PPH and blood transfusion.
Study context
- Population
- Consecutive cesarean deliveries at one institution over 1 yr, uterine tone rated on 11-point numeric rating scale (NRS) at 0, 5 and 10 min after placental delivery
- Participants
- 1,599 cesarean deliveries
- Outcome
- Major PPH (quantitative blood loss ≥1,500 ml), predicted by 10-min uterine tone NRS (0 to 10)
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
Major PPH predicted by 10-min uterine tone NRS
AUC of 10-min NRS for major PPH
0.78
95% CI 0.73 to 0.82
Increase in risk of major PPH per 1-point decrease in NRS
71%
95% CI 0.58 to 0.86, as printed
PPV of 10-min NRS ≤6 for major PPH
32.9%
Observational data: associations, not effects.
Secondary outcomes
Incidence of major PPH and transfusion
- Major PPH
- 9.9%
- Transfusion
- 6.7%
PPV of 10-min NRS ≤6 for PPH and transfusion
- PPH
- 64.2%
- Transfusion
- 20.6%
Feasibility: NRS documentation rate
- 0 min
- 91.6%
- 5 min
- 97.4%
- 10 min
- 97.0%
Original publication
Uterine Tone Numeric Rating Score as an Early Indicator of Major Postpartum Hemorrhage during Cesarean Delivery: A Prospective Observational Study. Anesthesiology. Published 11 April 2025. doi:10.
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