Analysis on the risk factors of postpartum bleeding equal or greater than 500 ml for elderly parturient women and Nomogram model construction and prediction validation
Objective To predict the risk of postpartum hemorrhage equal or greater than 500 ml for elderly parturient women by Nomogram model,provide a basis for prevention and control strategies in obstetric department and reduce postpartum hemorrhage risk.Methods A total of 1 358 elderly parturient women who gave birth in Hangzhou Obstetrics and Gynecology Hospital from January 2019 to January 2023 were selected as research objects.According to whether postpartum blood loss equal or greater than 500 ml,they were divided into observation group(equal or greater than 500 ml)and control group(less than 500 ml).LASSO analysis and logistic regression analy-sis were used to screen independent risk factors of postpartum blood loss equal or greater than 500 ml for elderly parturient women.R(R 3.5.3)software was used to establish Nomogram model for the prediction of postpartum blood loss equal or greater than 500 ml.Receiver op-erating characteristic(ROC)curve,decision curve,and calibration curve were used to verify the prediction value and clinical efficacy of No-mogram model,and importance matrix analysis was conducted.Results There were 120 cases with postpartum bleeding equal or greater than 500 ml in 1 358 elderly parturient women,including 104 cases with early hemorrhage and 16 cases with late hemorrhage.The average blood loss was(1 267.58±332.29)ml.Multivariate logistic regression analysis showed that placenta previa,hypertensive disorder complica-ting pregnancy,macrosomia,cicatricial uterus,contraction fatigue,Self-rating Anxiety Scale(SAS)score,and D-dimer were risk factors for postpartum bleeding equal or greater than 500 ml.Correction curve showed that the model consistency index(C-index)was 0.871(95％CI:0.865-0.978),and correction curve was basically consistent with the ideal curve.The area under ROC curve(AUC)was 0.951(95％CI:0.896-0.971).Uterine fatigue,SAS score,hypertensive disorder complicating pregnancy,cicatricial uterus,and macrosomia were of high importance,and the difficulty of improvement was low,so they entered into the priority improvement area.Conclusion Cicatricial ute-rus,SAS score,placenta previa,D-dimer,hypertensive disorder complicating pregnancy,macrosomia,and uterine fatigue are the influen-cing factors of postpartum bleeding equal or greater than 500 ml in elderly parturient women.Therefore,targeted prevention and treatment measures can be developed to further improve the prognosis.
Elderly parturient womanPostpartum blood lossRisk factorModel construction
NETL
NSTL
万方数据
