Establishment and validation of a nomogram model for the risk of postpartum hemorrhage in multipara with vaginal delivery
Objective To analyze the risk factors of postpartum hemorrhage(PPH)in multipara with vaginal delivery,and establish an individualized Nomogram model for predicting the risk.Methods The clinical data of 7,207 cases of multipara with vaginal delivery in Guangxi Zhuang Autonomous Region Maternal and Child Health Hospital from January 2018 to June 2022 were retrospectively analyzed,and the subjects were randomly divided into the modeling group(70%)and the validation group(30%),according to whether PPH occurred,the subjects were divided into PPH group(n =238)and non-PPH group(n =6,969).The clinical indicators of the non-PPH and PPH groups were compared,the indicators in the data of modeling group with statistically significant differences were used as the independent variables,and whether the occurrence of PPH as the outcome variable,were included in the multivariate Logistic regression analysis,and a nomogram was drawn.The data of the validation group was used for validation to draw the receiver operating characteristic(ROC)curve and calculate the area under ROC curve(AUC)to determine the model discrimination ability.The calibration chart was drawn to determine the model calibration ability.Results The age(χ2 =12.583),bleeding history during pregnancy(χ2 =10.576),gestational hypertension(χ2 =18.066),gestational diabetes(χ2 =42.775),preeclampsia(χ2 =10.165),multiple pregnancy(χ2 =16.467),prolonged labor(χ2 = 7.570),macrosomia(χ2 =14.306),abnormal blood coagulation(χ2 =62.961),uterine atony(χ2 = 32.305),placenta previa(χ2 =20.374),placental abruption(χ2 =61.508),and placental adhesion/retention(χ2 =24.086)had significant differences(P＜0.05)between PPH and non-PPH group.The results of multivariate Logistic regression analysis showed that history of bleeding during pregnancy(OR =3.003,95%CI:1.393-5.818),preeclampsia(OR =2.751,95%CI:1.347-5.106),multiple pregnancy(OR = 3.990,95%CI:1.769-8.054),prolonged labor(OR =1.861,95%CI:1.140-2.903),macrosomia(OR = 2.204,95%CI:1.431-3.287),abnormal blood coagulation(OR =6.221,95%CI:3.605-10.293),uterine inertia(OR=2.553,95%CI:1.778-3.597),placenta previa(OR=3.858,95%CI:2.139-6.537),placental abruption(OR=4.431,95%CI:2.818-6.762),placental adhesion/retention(OR =3.324,95%CI:1.969-5.353)were independent risk factors for PPH.After data verification in the validation group,the AUC of the ROC curve was 0.785,the calibration curve of the model in the calibration chart was close to the standard curve.Conclusions Bleeding history during pregnancy,preeclampsia,multiple pregnancy,prolonged labor,macrosomia,abnormal blood coagulation,uterine atony,uterine inertia placenta previa,placental abruption,placental adhesion/retention were independent risk factors for PPH.
NETL
NSTL
万方数据
维普
