Volkan Özgür AKBULUT, Can Ozan ULUSOY, Aziz KINDAN, Ahmet KURT, Ayşe Gizem YILDIZ, Gözde Başpınar DOĞRU, Hasan ALTINSOY, Yaprak Engin ÜSTÜN
Van Medical Journal - 2026;33(1):104-111
Introduction: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide, particularly in hypertensive pregnancies. Identifying high-risk patients early is crucial for timely intervention. This study aims to develop and compare machine learning-based and conventional statistical models to predict PPH in hypertensive pregnancies using key clinical indicators, including hemoglobin levels, mean arterial pressure (MAP), and pulse rate. Methods: This retrospective case-control study was conducted between 2016 and 2020 at a tertiary referral center in Turkey. A total of 64 pregnant women with hypertensive disorders of pregnancy (HDP) were included, with 32 developing PPH and 32 serving as controls. Logistic regression and random forest algorithms were used to assess the predictive significance of hemoglobin levels, MAP, and pulse rate. Hyperparameter tuning was performed using GridSearchCV with 5-fold cross-validation. Model performance was evaluated using sensitivity, specificity, F1-score, accuracy, and area under the receiver operating characteristic curve (AUC-ROC). Results: Hemoglobin levels were significantly lower (9.7 g/dL vs. 11.9 g/dL, p=0.002), while MAP (103.0 mmHg vs. 96.7 mmHg) and pulse rate (90.0 bpm vs. 86.0 bpm) were significantly higher in the PPH group. Logistic regression demonstrated higher sensitivity (0.55 vs. 0.44) and positive predictive value (PPV) (0.83 vs. 0.80) compared to the random forest model. However, the random forest model had a lower shrinkage value (-0.001 vs. -0.116), suggesting better generalizability. A MAP >=109.4 mmHg, pulse rate >=97.6 bpm, and hemoglobin level <9.23 g/dL were associated with a 94% probability of developing PPH. Conclusion: This study demonstrates that hemoglobin levels, MAP, and pulse rate can help identify hypertensive pregnant women at risk for PPH, emphasizing the need for early risk stratification to improve maternal outcomes.
