Clinical Outcomes, Incidence, Associated Factors, and Prediction Model of Intensive Care Unit Admission in Women With Postpartum Hemorrhage Following Cesarean Delivery: A Secondary Analysis of a Tertiary-Care Cohort in Thailand.

OBJECTIVES: We aimed to determine the clinical outcomes, incidence, associated factors, and a predictive model for intensive care unit (ICU) admission among patients with postpartum hemorrhage (PPH) following cesarean delivery. STUDY DESIGN: Secondary analysis of a retrospective cohort of parturients with PPH following cesarean delivery between January 1, 2016, and December 31, 2020. METHODS: Patients with an estimated blood loss < 1000 mL or incomplete data were excluded. Perioperative, obstetric, and anesthetic variables were evaluated. Multivariable logistic regression identified factors associated with ICU admission. Results are reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS: Of 649 eligible patients, 44 (6.78%; 95% CI, 5.09-8.98) were admitted to the ICU. Estimated blood loss > 2200 mL (aOR 16.51; 95% CI, 7.28-37.45; p < 0.001) strongly predicted ICU admission. Other independent predictors were general anesthesia (aOR, 4.12; 95% CI, 1.76-9.65; p = 0.001) and gestational age < 36.2 weeks (aOR, 2.28; 95% CI, 1.11-4.67; p = 0.024). Emergency cesarean delivery was also predictive (aOR, 2.25; 95% CI, 1.02-4.92; p = 0.043). Among ICU admissions, 37/44 (84.1%) required mechanical ventilation. The median ICU length of stay was 1 day (IQR, 1-2). ICU patients had higher rates of blood transfusion, hysterectomy, and reoperation than non-ICU patients (all p < 0.001). An exploratory prediction model incorporating these variables demonstrated good discrimination (AUC 0.891; 95% CI 0.835-0.946). CONCLUSIONS: ICU admission was associated with more severe maternal illness and adverse perioperative outcomes. Factors associated with ICU admission included severe blood loss, general anesthesia, earlier gestational age, and emergency cesarean delivery. Recognition of these characteristics may facilitate timely escalation of monitoring and multidisciplinary management when severe PPH occurs. Trial Registration: ClinicalTrials.gov identifier: NCT04833556.