Huang et al reported the MONITOR model for predicting postpartum hemorrhage in a woman with immune thrombocytopenia purpura (ITP). The authors are from multiple institutions in China.
Patient selection: postpartum state for a woman with ITP
MONITOR is an acronym based on single letters from: maternal complication, WHO bleeding score, antepartum plateelt transfusion, placental abnormalities, platelet count, previous uterine surgery, primiparity.
Parameters:
(1) primiparity
(2) previous uterine surgery
(3) placental abnormalities (placenta previa; placenta accreta/increta/percreta; abruption)
(4) maternal complication (gestational hypertension; gestational diabetes)
(5) antepartum platelet transfusion
(6) platelet count in 10^9/L
(7) WHO bleeding score
|
Parameter
|
Finding
|
beta-coefficient
|
Points
|
|
primiparity
|
no
|
0
|
0
|
|
|
yes
|
2.073
|
3
|
|
previous uterine surgery
|
no
|
0
|
0
|
|
|
yes
|
2.333
|
3
|
|
placental abnormalities
|
no
|
0
|
0
|
|
|
yes
|
2.706
|
3.5
|
|
maternal complication
|
no
|
0
|
0
|
|
|
yes
|
0.730
|
1
|
|
platelet transfusion
|
no
|
0
|
0
|
|
|
yes
|
1.137
|
1.5
|
|
platelet count
|
|
-0.010 * (count)
|
0 if > 100; 1 if 20 to 100; 3 if < 20
|
|
WHO bleeding score
|
0
|
0
|
0
|
|
|
1
|
0.944
|
1
|
|
|
>= 2
|
2.699
|
3.5
|
value of X =
= SUM(points for all of the beta-coefficients) - 4.479
probability of hemorrhage =
= 1 / (1 + EXP((-1) * X))
total score =
= SUM(points for all of the parameters)
Interpretation:
• mininum score: 0
• maximum score: 18.5
Performance:
• The area under the ROC curve was 0.87 in internal validation cohort.
