建立双胞胎产后出血预测模型:一项回顾性研究
Sangsang Qi1,2, Xianhu Fu3
1Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, No. 339 Liuting Street, Haishu District, 315012, Ningbo, China.
BMC pregnancy and childbirth
|September 7, 2023
概括
这项研究确定了双胞胎怀孕中产后出血的关键风险因素,并开发了一种预测模型,以帮助临床决策. 该模型有效评估风险,使个性化预防策略能够获得更好的孕产妇结果.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 生殖健康 生殖健康
背景情况:
- 产后出血 (PPH) 是全球孕产妇发病率和死亡率的一个重要原因.
- 双胞胎怀孕与单独怀孕相比,与PPH的风险更高有关.
- 确定特定的风险因素和开发双胞胎妊娠中PPH的预测工具对于及时干预至关重要.
研究的目的:
- 为了确定与双胞胎怀孕中产后出血相关的独立风险因素.
- 开发和验证双胞胎怀孕中产后出血的预测模型 (nomogram).
主要方法:
- 一项回顾性研究涉及2045名在宁波妇女和儿童医院分娩双胞胎婴儿的患者 (2018年1月至2022年8月).
- 患者被分为训练 (n=1395) 和验证 (n=650) 队列.
- 使用LASSO和多因素逻辑回归分析来识别风险因素;使用ROC曲线,Hosmer-Lemeshow测试和决策曲线分析构建和验证名图.
主要成果:
- 双胞胎怀孕中PPH的独立风险因素包括母亲的年龄,辅助生殖,低血小板数量,低纤维素和白蛋白水平,高血压障碍,胎盘前,先前剖腹产,先前子宫内手术和高新生儿体重.
- 预测模型表现良好,在培训队列中,曲线下的面积 (AUC) 为0.810,在验证队列中为0.821.
- 该模型显示了可接受的灵敏度和特异性,在两个队列中都有高负预测值.
结论:
- 一个包含已识别的风险因素的验证预测模型可以有效地评估双胞胎怀孕中产后出血的风险.
- 这种工具可以帮助临床医生实施个性化的预防措施,有可能减少高风险双胞胎怀孕中PPH的发生率和严重程度.
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