二胎阴道分娩产妇产后出血预测模型的构建

Construction of a predictive model for postpartum hemorrhage in parturients undergoing vaginal delivery with a second child

目的:探讨二胎阴道分娩产妇产后出血的相关危险因素并建立风险预测模型。方法:采用便利抽样法,选取2019年7月-2023年3月在北京大学第三医院规律产检的2 500名二胎阴道分娩产妇为研究对象,根据失血量,将胎儿娩出后24 h内失血量≥500 m1的产妇作为病例组( n=278),同期分娩的胎儿娩出后24 h内失血量<500 ml的产妇作为对照组( n=2 222)。采用单因素分析、二项Logistic回归分析探讨二胎阴道分娩产妇产后出血的影响因素,基于筛选出的危险因素使用R软件建立列线图预测模型,并对模型进行一致性检验。 结果:2 500名二胎阴道分娩产妇产后出血发生率为11.12%(278/2 500)。二项Logistic回归分析结果显示,体外受精-胚胎移植、临产前体重指数、会阴侧切、新生儿体重、前置胎盘、胎盘植入、手取胎盘是二胎阴道分娩产妇发生产后出血的影响因素( P<0.05)。根据影响因素建立预测二胎阴道分娩产妇产后出血发生概率的列线图,预测模型 C- index为0.706,受试者工作特征曲线下面积为0.706,Hosmer-Lemeshow拟合优度检验显示χ 2值为7.720( P=0.461)。 结论:体外受精-胚胎移植、临产前体重指数、会阴侧切、新生儿体重、前置胎盘、胎盘植入、手取胎盘是二胎阴道分娩产妇产后出血的危险因素。根据危险因素构建的预测模型具有一定的准确性,对于预测二胎阴道分娩产妇的产后出血有一定的临床价值。

ObjectiveTo explore the risk factors of postpartum hemorrhage in parturients undergoing vaginal delivery with a second child and establish a risk prediction model.MethodsUsing the convenient sampling method,a total of 2500 parturients undergoing vaginal delivery with a second child who underwent regular prenatal examinations at Peking University Third Hospital from July 2019 to March 2023 were selected as the research objects.According to the amount of blood loss,parturients with blood loss greater than or equal to 500 ml within 24 hours after delivery were selected as the case group(n=278),while parturients with blood loss less than 500 ml within 24 hours after delivery in the same period were selected as the control group(n=2222).Univariate analysis and binomial Logistic regression were used to analyze the influencing factors of postpartum hemorrhage in parturients with vaginal delivery with a second child.Based on the selected risk factors,a nomogram prediction model was established using R software,and the consistency of the model was tested.ResultsThe incidence of postpartum hemorrhage in 2500 parturients undergoing vaginal delivery with a second child was 11.12%(278/2500).Binomial Logistic regression analysis showed that in in vitro fertilization-embryo transfer,pre-delivery body mass index,lateral perineal incision,neonatal weight,placenta previa,placenta implantation and manual extraction of placenta were the influencing factors for postpartum hemorrhage in parturients undergoing vaginal delivery with a second child(P<0.05).According to the influencing factors,a nomogram model was established to predict the probability of postpartum hemorrhage in women who gave birth to a second child.The C-index of the prediction model was 0.706,the area under the receiver operating characteristic curve was 0.706,and the χ^(2) value of the Hosmer-Lemeshow goodness-of-fit test was 7.720(P=0.461).ConclusionsIn vitro fertilization embryo transfer,pre-delivery body mass index,perineal lateral resection,neonatal weight,placenta previa,placental implantation and manual extraction of placenta are risk factors for postpartum hemorrhage in parturients undergoing vaginal delivery for a second child.The prediction model constructed based on risk factors has certain accuracy and clinical value for predicting postpartum hemorrhage in parturients with vaginal delivery of a second child.