HEMSTOP bleeding score weakly predicts postpartum hemorrhage risk: BMC

A new study published in the journal of BMC Pregnancy and Childbirth revealed that postpartum hemorrhage (PPH) is not well predicted by the HEMSTOP bleeding score.

In high-income nations, postpartum hemorrhage affects 5% of births and continues to be the primary cause of maternal morbidity and death globally. In order to start active management of delivery and early detection and treatment of PPH, it is imperative to identify women who are at greater risk. Inherited mild-to-moderate bleeding disorders (MBDs) are one of the maternal risk factors for PPH that may be identified and treated.

High percentages of MBDs were identified in 2 recent studies examining hemostasis in women following severe PPH (23% and 56%, respectively). The women in these studies were sent to hemostasis specialists due to an unusual PPH course. The function of MBDs in PPH, particularly in unselected parturients, is therefore little understood. This study was to ascertain the predictive usefulness of the HEMSTOP bleeding score for the incidence of PPH in unselected parturients using prospective data and various adjusted analyses.

Women who completed the HEMSTOP questionnaire before to delivery and had no known bleeding disorders or antithrombotic medications were included in a prospective cohort research that was carried out in a tertiary maternity hospital between 2014 and 2016. Primary PPH > 500 mL after birth was the main result. This research looked at the bleeding score, which ranges from 0 to 7, as an ordinal and continuous variable. They adjusted for PPH risk variables in our multivariable analysis. Also, this study calculated the prognostic accuracy metrics for the bleeding score.

Out of 2,536 women, 116 (4.6%) experienced PPH. When compared to a score of 0, elevated bleeding scores were linked to increased PPH risk, showing a progressive increase in risk along with score escalation (adjusted RR = 1.58; 95% CI, 1.01 to 2.46 for a score of one, adjusted RR = 2.11, 95% CI 0.86 to 5.20 for a score of two, and adjusted RR = 7.20, 95% CI 2.54 to 20.41 for a score of three; P < 0.001).

The accuracy of the bleeding score in predicting PPH had an area under the curve of 0.56. Overall, the evaluation of main PPH risk benefits from the computation of the HEMSTOP bleeding score in pregnant women who are not chosen.

Reference:

Deleu, F., Nebout, S., Peynaud-Debayle, E., Mandelbrot, L., & Keita, H. (2025). A high HEMSTOP bleeding score is a major independent risk factor for postpartum hemorrhage: a prospective cohort study. BMC Pregnancy and Childbirth, 25(1). https://doi.org/10.1186/s12884-025-07281-0