双胎妊娠产后出血预测评分系统模型的建立

Establishment of a Scoring System for Predicting Postpartum Hemorrhage in Twin Pregnancy

目的:建立双胎妊娠孕妇产后出血的预测评分模型,分析此评分系统的产前预测作用,以指导临床更有针对性地制定双胎产后出血预防措施。方法:收集2019年1月至2020年12月于本院系统产前检查并住院分娩的双胎妊娠孕产妇763例,回顾性分析影响产后出血的相关因素,对筛选出的高危因素影响权重量化评分,赋值后建立基于高危因素的双胎妊娠产后出血预测评分系统,并利用受试者工作曲线(ROC)评价此评分系统的灵敏度及准确度,并确定界值。结果:(1)产前因素分析显示孕妇年龄、孕前体质量指数(BMI)、孕期体质量增加、B超估重(双胎儿体质量和)、妊娠合并前置胎盘、妊娠期高血压疾病共6个产前变量对双胎妊娠产后出血具有明显影响。(2)对这些产前高危因素影响权重进行量化,构造出产后出血预测评分系统,根据评分值分为0~14分组、15~25分组、26~60分组3组。0~14分组产后出血率低(0),26~60分组产后出血率较高(35.05%),3组间比较差异有统计学意义(P <0.01)。绘制ROC,曲线下面积(AUC)为0.833,根据约登指数确定对应界值为25分,在此临界值下,灵敏度和特异度分别为0.773和0.813。结论:孕妇年龄、孕期体质量增加、产前BMI、双胎儿体质量和、妊娠合并前置胎盘、妊娠期高血压疾病是影响双胎妊娠孕妇产后出血的产前因素,对各影响因素的影响权重进行赋值后,总分达25分产后出血率明显增高。

Objective: To establish a predictive scoring model of postpartum hemorrhage in twin pregnancy,and analyze the predictive function of this scoring system before delivery for pertinentguidance of the postpartum hemorrhage prevention in twins. Methods: Clinical data of 763 cases of parturient women who gave birth in our hospital from January 2019 to December 2020 were collected. The related factors of postpartum hemorrhage were analyzed retrospectively. A high-risk factor-based scoring system for predicting postpartum hemorrhage in twins was established. Sensitivity and accuracy of the scoring system were evaluated by receiver operating curve( ROC). Results:(1)Prenatal factors analysis showed that 6 prenatal variableshad significant effects on postpartum hemorrhage of twin pregnancy,including gestational age,pre-pregnancy body mass index( BMI),weight gain during pregnancy,B ultrasound weight estimation,pregnancy with placenta previa,hypertensive disorder complicating pregnancy.(2)Quantifying the influence weight of these high risk factors before delivery,and constructing the score system of postpartum hemorrhage,which was divided into 3 groups,0-14,15-25 and 26-60. The rate of postpartum hemorrhage was lower in 0-14 group than that in 26-60 group( 35. 05%). There weresignificant differencesamongthe three groups( P < 0. 01). The area under the curve was 0. 833,and the corresponding threshold was 25 according to the Yoden Index. Under this threshold,the Sensitivity and specificity were 0. 773 and 0. 813. Conclusions: Maternal age,weight gain during pregnancy,prenatal BMI,twin fetal constitution,pregnancy with placenta previa,and hypertensive disorder complicating pregnancy would influence postpartum hemorrhage in twin pregnancy. Postpartum hemorrhage rate was significantly higherwhen the total score arrive 25.