摘要
目的:探讨低危产妇经阴道分娩产后出血的相关因素并构建产后出血风险预测模型,为预测产后出血的风险提供依据。方法:选取2019年6月—2022年12月在汕头大学医学院第二附属医院住院的429例经阴道分娩、无妊娠并发症及合并症的单胎低危产妇为研究对象。根据纳入时间排序,将研究对象分为训练集(331例)和验证集(98例)。以是否发生产后出血,训练集分为出血组(112例)、未出血组(219例),验证集分为出血组(32例)、未出血组(66例)。通过多因素logistic回归分析筛选产后出血的相关因素并构建列线图预测模型。采用受试者工作特征(receiver operating characteristic,ROC)曲线下面积评估预测模型的区分度。采用Hosmer-Lemeshow(HL)拟合优度检验及校准曲线评估预测模型的校准度。结果:多因素logistic回归分析显示产妇的宫高(OR=1.326,95%CI:1.179~1.446)、产前体重指数(OR=1.111,95%CI:1.020~1.211)、孕次(OR=2.128,95%CI:1.167~3.879)、第三产程时间(OR=1.072,95%CI:1.022~1.124)、血小板计数(OR=0.990,95%CI:0.986~0.996)是产后出血的相关因素。由这5个因素构建的预测模型在训练集的ROC曲线下面积为0.786(95%CI:0.732~0.839),验证集ROC曲线下面积为0.840(95%CI:0.803~0.869),训练集HL检验的P值为0.529,验证集HL检验的P值为0.893,校准曲线均接近理想曲线,表明预测模型的区分度、校准度均良好。结论:本研究构建的预测模型对低危产妇经阴道分娩产后出血的风险有较好的预测能力。
Objective:To investigate the factors associated with postpartum hemorrhage in low-risk women who deliver vaginally and to construct a postpartum hemorrhage risk prediction model to provide a basis for predicting the risk of postpartum hemorrhage.Methods:429 cases of singleton low-risk women who delivered vaginally without pregnancy complications and comorbidities in the Second Affiliated Hospital of Shantou University Medical College from June 2019 to December 2022 were selected as the study subjects.The study subjects were divided into a training set(331 cases)and a validation set(98 cases)according to the order of inclusion time.In terms of whether postpartum hemorrhage occurred,the training set was divided into the bleeding group(112 cases)and the non-bleeding group(219 cases),and the validation set was divided into the bleeding group(32 cases)and the non-bleeding group(66 cases).The correlates of postpartum hemorrhage were screened by multivariate logistic regression analysis and a nomogram prediction model was constructed.The area under the curve of the receiver operating characteristic(ROC)was used to assess the discrimination of the prediction model.The calibration of the predictive model was assessed using the Hosmer-Lemeshow(HL)goodness-of-fit test and calibration curve.Results:Multivariate logistic regression analysis showed that maternal uterine height(OR=1.326,95%CI:1.179-1.446),prenatal body mass index(OR=1.111,95%CI:1.020-1.211),gestational age(OR=2.128,95%CI:1.167-3.879),duration of third stage of labor(OR=1.072,95%CI:1.022-1.124),and platelet count(OR=0.990,95%CI:0.986-0.996)were correlates of postpartum hemorrhage.The area under the ROC curve of the prediction model constructed from these five factors was 0.786(95%CI:0.732-0.839)in the training set,and the area under the ROC curve was 0.840(95%CI:0.803-0.869)in the validation set.The P value of the HL test for the training set was 0.529,and the P value of the HL test for the validation set was 0.893,and the calibration curves were all close to th
作者
钟煊
陈佩珊
ZHONG Xuan;CHEN Peishan(Department of Obstetrics,The Second Affiliated Hospital of Shantou University Medical College,Shantou 515041,China)
出处
《汕头大学医学院学报》
2024年第1期16-20,共5页
Journal of Shantou University Medical College
关键词
产后出血
低危产妇
阴道分娩
风险预测
postpartum hemorrhage
low-risk women
vaginal delivery
risk prediction
