Establishment and verification of risk prediction model for postpartum hemorrhage in pregnant women with pernicious placenta previa
Objective To construct a risk prediction model for postpartum hemorrhage in pregnant women with pernicious placenta previa (PPP) and test its predictive performance.Methods A total of 196 PPP pregnant women admitted to the hospital from January 2021 to June 2022 were selected as the study ob-jects.According to whether postpartum hemorrhage occurred or not,they were divided into the postpartum hemorrhage group (n=72) and group without postpartum hemorrhage (n=124).The clinical data of preg-nant women were collected,and the influencing factors of postpartum hemorrhage were analyzed by univariate analysis and multivariate logistic regression model.Based on the selected influencing factors,R3.5.3 software were used to draw a nomogram model for predicting the risk of postpartum hemorrhage of PPP pregnant women,and its predictive performance and goodness-of-fit was tested by receiver operating characteristic (ROC) curve and Hosmer-Lemeshow model,respectively.In addition,98 PPP pregnant women admitted to the hospital from July 2022 to June 2023 were included for external verification of the risk prediction model. Results Multivariate logistic regression analysis results showed that the increased age of pregnant women, number of cesarean sections (≥2),placenta adherence,placenta accretion,type of placenta previa (partial/cen-tral),time since last cesarean section (<3 years),placenta previa in previous cesarean section,and hospital classification of previous cesarean section (grade 2 and below) were all independent risk factors for postpar-tum hemorrhage in PPP pregnant women (P<0.05).Based on the above eight independent risk factors,a no-mogram model was established to predict the risk of postpartum hemorrhage in PPP pregnant women.The ar-ea under the ROC curve (AUC) of the model was 0.816 (95％CI:0.795 -0.838),the sensitivity was 78.45％,and the specificity was 86.38％.Hosmer-Lemeshow test showed that the model had a good fit (X2=5.126,P=0.358).External validation:among 98 PPP pregnant women,postpartum hemorrhage occurred in 35 cases,and 32 cases were predicted by this model,with an AUC of 0.786 (95％CI:0.723-0.801).The sen-sitivity was 72.48％,and the specificity was 83.49％.Hosmer-Lemeshow test showed that the model had a good fit (X2=5.496,P=0.382).Conclusion Based on the age of pregnant women,number of cesarean sec-tions,placenta adherence,placenta accretion,type of placenta previa,time since last cesarean section,placenta previa and hospital classification in previous cesarean section,the PPP nomogram model for predicting post-partum hemorrhage risk has been established,and has certain clinical predictive value for PPP postpartum hemorrhage.
placenta previapostpartum hemorrhageinfluencing factornomogramrisk prediction model
万方数据
维普
