Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
Int J Obstet Anesth. 2022 Aug;51:103550. doi: 10.1016/j.ijoa.2022.103550. Epub 2022 Apr 22.
Uterine atony is the most common cause of postpartum hemorrhage and is associated with substantial morbidity. Prospectively identifying women at increased risk of atony may reduce the incidence of subsequent adverse events. We sought to develop and evaluate clinical risk-prediction models for uterine atony following vaginal and cesarean delivery, using prespecified risk factors identified from systematic review.
Using retrospective data from vaginal and cesarean deliveries occurring at a single institution between 2010 and 2019, antepartum and intrapartum risk-prediction models for uterine atony, defined by supplementary uterotonic administration in addition to prophylactic oxytocin infusion, were developed using logistic regression. The C-statistic quantified the ability of the model to discriminate between cases and controls.
Data were available for 4773 atony cases and 23 933 controls. The antepartum model included 20 risk factors and exhibited moderate discriminatory ability (C-statistic 0.61, 95% confidence interval 0.60 to 0.62). The intrapartum model included 27 risk factors and showed improved discriminatory ability (C-statistic 0.68, 95% confidence interval 0.67 to 0.69).
We identified antepartum and intrapartum risk-prediction models to quantify patients' risk of uterine atony. Models performed similarly for all delivery modes, races, and ethnic groups. Future work should further improve these models through inclusion of more comprehensive prediction data.
子宫收缩乏力是产后出血的最常见原因，与大量发病率相关。前瞻性地识别出子宫收缩乏力风险增加的妇女可能会降低随后发生不良事件的发生率。我们试图使用系统评价中确定的预设风险因素，为阴道分娩和剖宫产分娩后发生的子宫收缩乏力开发和评估临床风险预测模型。
使用单家机构 2010 年至 2019 年期间阴道分娩和剖宫产的数据，使用逻辑回归为子宫收缩乏力（定义为除预防性催产素输注外还需要补充宫缩剂）开发了产前和产时的风险预测模型。C 统计量量化了模型区分病例和对照组的能力。
共有 4773 例宫缩乏力病例和 23933 例对照资料可用。产前模型包括 20 个风险因素，具有中等的区分能力（C 统计量为 0.61，95%置信区间为 0.60 至 0.62）。产时模型包括 27 个风险因素，显示出改善的区分能力（C 统计量为 0.68，95%置信区间为 0.67 至 0.69）。
我们确定了产前和产时的风险预测模型，以量化患者发生子宫收缩乏力的风险。这些模型在所有分娩方式、种族和族裔群体中的表现相似。未来的工作应通过纳入更全面的预测数据来进一步改进这些模型。
