预测前置胎盘妊娠产后大出血的评分模型：一项回顾性队列研究。
Scoring model to predict massive post-partum bleeding in pregnancies with placenta previa: A retrospective cohort study.
作者信息
Lee Ji Yeon, Ahn Eun Hee, Kang Sukho, Moon Myung Jin, Jung Sang Hee, Chang Sung Woon, Cho Hee Young
机构信息
Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea.
出版信息
J Obstet Gynaecol Res. 2018 Jan;44(1):54-60. doi: 10.1111/jog.13480. Epub 2017 Oct 25.
AIM
We aimed to identify factors associated with massive post-partum bleeding in pregnancies with placenta previa and to establish a scoring model to predict post-partum severe bleeding.
METHODS
A retrospective cohort study was performed in 506 healthy singleton pregnancies with placenta previa from 2006 to 2016. Cases with intraoperative blood loss (≥2000 mL), packed red blood cells transfusion (≥4), uterine artery embolization, or hysterectomy were defined as massive bleeding. After performing multivariable analysis, using the adjusted odds ratios (aOR), we formulated a scoring model.
RESULTS
Seventy-three women experienced massive post-partum bleeding (14.4%). After multivariable analysis, seven variables were associated with massive bleeding: maternal old age (≥35 years; aOR 1.79, 95% confidence interval [CI] 1.00-3.20, P = 0.049), antepartum bleeding (aOR 4.76, 95%CI 2.01-11.02, P < 0.001), non-cephalic presentation (aOR 3.41, 95%CI 1.40-8.30, P = 0.007), complete placenta previa (aOR 1.93, 95%CI 1.05-3.54, P = 0.034), anterior placenta (aOR 2.74, 95%CI 1.54-4.89, P = 0.001), multiple lacunae (≥4; aOR 2.77, 95%CI 1.54-4.99, P = 0.001), and uteroplacental hypervascularity (aOR 4.51, 95%CI 2.30-8.83, P < 0.001). We formulated a scoring model including maternal old age (<35: 0, ≥35: 1), antepartum bleeding (no: 0, yes: 2), fetal non-cephalic presentation (no: 0, yes: 2), placenta previa type (incomplete: 0, complete: 1), placenta location (posterior: 0, anterior: 1), uteroplacental hypervascularity (no: 0, yes: 2), and multiple lacunae (no: 0, yes: 1) to predict post-partum massive bleeding. According to our scoring model, a score of 5/10 had a sensitivity of 81% and a specificity of 77% for predicting massive post-partum bleeding. The area under the receiver-operator curve was 0.856 (P < 0.001). The negative predictive value was 95.9%.
CONCLUSION
Our scoring model might provide useful information for prediction of massive post-partum bleeding in pregnancies with placenta previa.
目的
我们旨在确定与前置胎盘妊娠产后大出血相关的因素，并建立一个评分模型来预测产后严重出血。
方法
对2006年至2016年506例健康单胎前置胎盘妊娠进行回顾性队列研究。术中失血（≥2000 mL）、输注浓缩红细胞（≥4个单位）、子宫动脉栓塞或子宫切除术的病例被定义为大出血。进行多变量分析后，利用调整后的优势比（aOR），我们制定了一个评分模型。
结果
73名妇女发生了产后大出血（14.4%）。多变量分析后，七个变量与大出血相关：产妇高龄（≥35岁；aOR 1.79，95%置信区间[CI] 1.00 - 3.20，P = 0.049）、产前出血（aOR 4.76，95%CI 2.01 - 11.02，P < 0.001）、非头先露（aOR 3.41，95%CI 1.40 - 8.30，P = 0.007）、完全性前置胎盘（aOR 1.93，95%CI 1.05 - 3.54，P = 0.034）、胎盘前置（aOR 2.74，95%CI 1.54 - 4.89，P = 0.001）、多个血窦（≥4个；aOR
Zotero 插件