Predictive value and threshold effect analysis of serum calcium level in pregnant women for postpartum hemorrhage
Objective To investigate the predictive value and threshold effect of serum calcium(Ca)level on post-partum hemorrhage(PPH)in pregnant women.Methods A total of 280 pregnant women with postpartum hemorrhage who underwent vaginal delivery in our hospital from June 2019 to October 2022 were selected as the research objects.The patients with PPH(190 cases)were included in the training set to identify the risk factors of PPH and develop a predictive scoring model.Another patients(90 cases)were included in the validation set to verify the effectiveness of the predictive scoring sys-tem.The patients in the training set were divided into bleeding group(n=100)and non-bleeding group(n=90)according to whether they had postpartum hemorrhage.The general data of the two groups and the clinical indicators affecting PPH were compared.Multivariate Logistic regression analysis was used to analyze the risk factors affecting PPH.Restricted cubic spline Logistic regression model was used to analyze the dose-response relationship between serum Ca level and PPH risk in preg-nant women of different ages.Construct a predictive scoring model and evaluate the effectiveness of the model.Results Mul-tivariate Logistic regression analysis showed that soft birth canal injury or lateral incision,uterine fibroids,second stage of labor,fibrinogen(FIB)≤3 g/L,25-hydroxyvitamin D[25(OH)D]≤18 nmol/L,serum iron(SFE)≤14 mmol/L and Ca≤2.21 mmol/L were independent risk factors for PPH(P＜0.05).Restricted cubic spline model analysis showed that there was no non-linear relationship between serum Ca level and PPH risk among different ages(P＞0.05).The best boundary value of the training set and the validation set was 4.86 points.The model evaluation results showed that the prediction scoring model had high accuracy and discrimination.When the probability of risk threshold was between 1％and 98％,the model could produce net clinical benefit by identifying PPH risk,which had high clinical application value.Conclusion Ca≤2.21 mmo/L was an independent influencing factor for PPH,and there was no nonlinear dose-response relationship between serum Ca level and PPH risk in pregnant women of different ages.
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