# Predictive value of thyroid hormone levels for postpartum hemorrhage in hypothyroidism-complicated pregnancy

## TL;DR

This study shows that thyroid hormone levels can help predict postpartum hemorrhage in pregnant women with hypothyroidism.

## Contribution

The study identifies TSH and FT4 as independent predictors of postpartum hemorrhage in hypothyroidism-complicated pregnancies.

## Key findings

- TSH and FT4 were independent influencing factors for postpartum hemorrhage in hypothyroidism-complicated pregnancies.
- The combination of TSH and FT4 showed good predictive value with an AUC of 0.823.
- High TSH and low FT4 levels were linked to higher postpartum hemorrhage rates and lower newborn Apgar scores.

## Abstract

To explore the predictive value of thyroid hormone (TH) related indices for postpartum hemorrhage (PPH) in pregnant women with hypothyroidism-complicated pregnancy (HCP).

273 pregnant women with HCP admitted to our hospital from January 2021 to December 2024 were retrospectively selected. The patients were divided into PPH group (n=50) and non-PPH group (n=223) based on whether PPH occurred. The influencing factors were analyzed with univariate and Binary logistic regression analysis. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of TH related indices for PPH in pregnant women with HCP.

There were statistically significant differences in manual placental removal, delivery conditions, fetal weight >4000g, TSH, and FT4 (P < 0.05). The results of Binary logistic regression analysis showed that delivery conditions, TSH, and FT4 were independent influencing factors for PPH in pregnant women with HCP (P < 0.05). The ROC analysis results showed that the area under the curve for TSH+FT4 was 0.823, with a standard error of 0.032 (95% CI: 0.761~0.886), Youden index=0.48, sensitivity of 66.00%, and specificity of 81.61%. Patients with high TSH and low FT4 levels had lower Apgar scores for newborns and higher rates of postpartum hemorrhage.

TSH and FT4 have certain value in predicting PPH in pregnant women with HCP, and it is recommended to include them in predictive indices/models.