Department of Gynaecology and Obstetrics, Wenzhou Central Hospital, Wenzhou City, China.
J Matern Fetal Neonatal Med. 2023 Dec;36(2):2239983. doi: 10.1080/14767058.2023.2239983.
This study aims to analyze the risk factors associated with different degrees of postpartum hemorrhage in patients with pregnancy-induced hypertension and construct a prediction model using line graph.
The patients who were treated in our hospital for pregnancy-induced hypertension from January 2021 to December 2022 were enrolled as the study subjects. Their clinical data were collected, and the risk factors associated with postpartum hemorrhage in patients with pregnancy-induced hypertension were analyzed by single-factor and multi-factor logistic regression. The nomogram prediction model was constructed and validated internally, and the discrimination and consistency of the model were verified by the ROC curve and calibration graph.
In this experiment, 125 out of the 482 patients with hypertensive disorder complicating pregnancy experienced different degrees of postpartum hemorrhage, with an incidence of 25.93%. Multivariate Logistic regression analysis showed that patients with severe disease (OR = 2.454), the degree of proteinuria +++ or ++++ (OR = 6.754, 7.206), fetal body mass ≥4000 g (OR = 5.972), uterine atony (OR = 11.789), abnormal HDL-C (OR = 3.174), abnormal LDL-C (OR = 8.812), and abnormal VEGF (OR = 7.702) had a higher risk of postpartum hemorrhage ( < .05). The risk of postpartum hemorrhage was lower in patients with onset gestational week ≥28 weeks (OR = 0.158, 0.025) and delivery gestational week ≥28 weeks (OR = 0.085, 0.152) ( < .05). Columnar line graph models for postpartum hemorrhage in patients with gestational hypertension were constructed based on nine independent risk factors, and the model differentiation (AUC 0.912 and 0.919, respectively) and precision (goodness of fit HL = 8.441, = .392, = 7.741, = .459) were better in the modeling and validation groups.
The severity of disease, the gestational week upon onset, the gestational week upon delivery, the degree of proteinuria, systolic blood pressure, diastolic blood pressure, uterine atony, HDL-C, LDL-C, VEGF are factors affecting the incidence of postpartum hemorrhage in patients with hypertensive disorder complicating pregnancy. The prediction model based on the above factors can accurately evaluate the risk of different degrees of postpartum hemorrhage in patients with hypertensive disorder complicating pregnancy.
本研究旨在分析妊娠高血压患者不同程度产后出血的相关危险因素，并构建线图预测模型。
选取 2021 年 1 月至 2022 年 12 月在我院治疗的妊娠高血压患者为研究对象，收集其临床资料，采用单因素和多因素 logistic 回归分析妊娠高血压患者产后出血的相关危险因素，构建并内部验证列线图预测模型，通过 ROC 曲线和校准图验证模型的区分度和一致性。
本实验中，482 例妊娠高血压患者中 125 例出现不同程度的产后出血，发生率为 25.93%。多因素 Logistic 回归分析显示，疾病严重程度（OR=2.454）、蛋白尿程度+++或++++（OR=6.754、7.206）、胎儿体重≥4000g（OR=5.972）、子宫收缩乏力（OR=11.789）、高密度脂蛋白胆固醇异常（OR=3.174）、低密度脂蛋白胆固醇异常（OR=8.812）、血管内皮生长因子异常（OR=7.702）的患者产后出血风险较高（ < .05）。发病孕周≥28 周（OR=0.158、0.025）和分娩孕周≥28 周（OR=0.085、0.152）的患者产后出血风险较低（ < .05）。基于 9 个独立危险因素构建妊娠高血压患者产后出血的列线图模型，模型区分度（建模组 AUC 为 0.912，验证组 AUC 为 0.919）和精度（拟合优度 HL 分别为 8.441、 = .392、 = 7.741、 = .459）在建模和验证组中均较好。
疾病严重程度、发病孕周、分娩孕周、蛋白尿程度、收缩压、舒张压、子宫收缩乏力、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血管内皮生长因子是影响妊娠高血压患者产后出血发生率的因素。基于上述因素的预测模型可以准确评估妊娠高血压患者不同程度产后出血的风险。
