Zhou Yangzi, Song Zixuan, Wang Xiaoxue, Zhang Mingjie, Chen Xueting, Zhang Dandan
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China.
Front Physiol. 2022 Aug 22;13:982080. doi: 10.3389/fphys.2022.982080. eCollection 2022.
Pernicious placenta previa (PPP) is one of the most dangerous complications in pregnancy after cesarean section, with high perinatal mortality. This study aimed to develop a nomogram to predict postpartum hemorrhage in patients with PPP. A total of 246 patients with confirmed PPP at Shengjing Hospital of China Medical University from January 2018 to December 2021 were included. Patients were divided into to two cohorts depending on a postpartum blood loss of > 1000 ml ( = 146) or ≤ 1000 ml ( = 100). Lasso regression analysis was performed on the risk factors screened by univariate analysis to screen out the final risk factors affecting postpartum hemorrhage. Based on the final risk factors, a Nomogram prediction model with excellent performance was constructed using Logistic regression. A nomogram was constructed with further screening of the selected risk factors of postpartum hemorrhage in PPP. A second nomogram based only on the total ultrasonic risk score was constructed. Decision curve analysis (DCA) was used to evaluate the clinical efficacy of the nomograms. Older age, larger gestational age, larger neonatal birth weight, presence of gestational diabetes mellitus, larger amniotic fluid index, absence of gestational bleeding, and higher ultrasonic risk single score were selected to establish a nomogram for postpartum hemorrhage in PPP. The area under the curve of the nomogram constructed by Lasso regression analysis was higher than that of the ultrasonic total score alone (0.887 vs. 0.833). Additionally, DCA indicated better clinical efficacy in the former nomogram than in the later nomogram. Furthermore, internal verification of the nomogram constructed by Lasso regression analysis showed good agreement between predicted and actual values. A nomogram for postpartum hemorrhage in PPP was developed and validated to assist clinicians in evaluating postpartum hemorrhage. This nomogram was more accurate than using the ultrasonic score alone.
凶险性前置胎盘（PPP）是剖宫产术后妊娠最危险的并发症之一，围产儿死亡率高。本研究旨在建立一种列线图，用于预测PPP患者产后出血情况。纳入了2018年1月至2021年12月在中国医科大学附属盛京医院确诊为PPP的246例患者。根据产后失血量>1000 ml（n = 146）或≤1000 ml（n = 100）将患者分为两个队列。对单因素分析筛选出的危险因素进行Lasso回归分析，以筛选出影响产后出血的最终危险因素。基于最终危险因素，采用Logistic回归构建了性能优良的列线图预测模型。通过进一步筛选PPP产后出血的选定危险因素构建了列线图。构建了仅基于超声总风险评分的第二个列线图。采用决策曲线分析（DCA）评估列线图的临床疗效。选择年龄较大、孕周较大、新生儿出生体重较大、存在妊娠期糖尿病、羊水指数较大、无妊娠期出血以及超声风险单项评分较高的因素，建立PPP产后出血的列线图。Lasso回归分析构建的列线图曲线下面积高于单纯超声总分（0.887对0.833）。此外，DCA表明前一个列线图的临床疗效优于后一个列线图。此外，Lasso回归分析构建的列线图的内部验证显示预测值与实际值之间具有良好的一致性。开发并验证了PPP产后出血的列线图，以协助临床医生评估产后出血情况。该列线图比单独使用超声评分更准确。
