Lei Yan, Zhang Na, Liu Yu, Du Xin
Hubei Province Women and Children Hospital, Wuhan, 430070, China.
BMC Pregnancy Childbirth. 2025 Feb 3;25(1):107. doi: 10.1186/s12884-025-07255-2.
We aimed to establish a predictive nomogram to evaluate the incidence of residual tissue in patients with endogenic cesarean scar ectopic pregnancy after negative pressure aspiration.
This retrospective study included patients treated in the gynecology department of our institution from May 2017 to August 2023 who underwent negative pressure suction treatment, ultrasound examinations before and after treatment, and received telephone follow-up for at least 6 months. A total of 899 patients met the inclusion criteria and were divided into a training cohort (629 patients, 70%) and a validation cohort (270 patients, 30%). Independent predictive factors were established using multivariate logistic regression. The resulting nomogram was validated using 1,000 bootstrap resampling, and calibration curves were plotted. Receiver operating characteristic (ROC) analysis was performed to calculate the area under the curve, sensitivity, specificity, and other metrics to assess its discriminative performance. Clinical decision curves were constructed to evaluate clinical applicability and quantify the net benefit within a range of threshold probabilities. The model was externally validated in the validation cohort.
Predictive factors included in the nomogram included age (hazard ratio [HR]: 1.220, 95% confidence interval [CI]: 1.135-1.316), BMI (HR: 0.890, 95% CI: 0.796-0.986), intraoperative major hemorrhage (HR: 4.457, 95% CI: 1.610-12.292), maximum diameter of the gestational sac (HR: 1.572, 95% CI: 1.295, 1.914), and thickness of the remaining muscle layer of the lower uterine segment (HR: 1.572, 95% CI: 0.014, 0.430). The ROC curve of the resulting nomogram showed similar area under the curve values for the training (0.809, 95% CI: 0.751-0.867) and validation cohorts (0.814, 95% CI: 0.739, 0.888). The Hosmer-Lemeshow test indicated good model fit (P = 0.861), and the calibration curve was close to the ideal diagonal line. Decision curve analysis demonstrated good net benefit, and external validation confirmed its reliability.
The model may aid in individual clinical decision-making, allowing clinicians to perform immediate postoperative assessments for patients with endogenous ectopic pregnancy in cesarean section scars treated with negative pressure suction, identify high-risk subpopulations, and select appropriate supplementary treatment in advance, making it particularly suitable for low-income areas and resource-limited primary hospitals.
我们旨在建立一种预测列线图,以评估负压吸引术后内生性剖宫产瘢痕部位异位妊娠患者残留组织的发生率。
这项回顾性研究纳入了2017年5月至2023年8月在我院妇科接受治疗的患者,这些患者接受了负压吸引治疗、治疗前后的超声检查,并接受了至少6个月的电话随访。共有899例患者符合纳入标准,分为训练队列(629例患者,70%)和验证队列(270例患者,30%)。使用多因素逻辑回归确定独立预测因素。使用1000次自抽样对所得列线图进行验证,并绘制校准曲线。进行受试者操作特征(ROC)分析以计算曲线下面积、敏感性、特异性和其他指标,以评估其判别性能。构建临床决策曲线以评估临床适用性,并在一系列阈值概率范围内量化净效益。该模型在验证队列中进行外部验证。
列线图中纳入的预测因素包括年龄(风险比[HR]:1.220,95%置信区间[CI]:1.135-1.316)、体重指数(HR:0.890,95%CI:0.796-0.986)、术中大出血(HR:4.457,95%CI:1.610-12.292)、妊娠囊最大直径(HR:1.572,95%CI:1.295,1.914)以及子宫下段剩余肌层厚度(HR:1.572,95%CI:0.014,0.430)。所得列线图的ROC曲线显示,训练队列(0.809,95%CI:0.751-0.867)和验证队列(0.814,95%CI:0.739,0.888)的曲线下面积值相似。Hosmer-Lemeshow检验表明模型拟合良好(P = 0.861),校准曲线接近理想对角线。决策曲线分析显示净效益良好,外部验证证实了其可靠性。
该模型可能有助于个体临床决策,使临床医生能够对接受负压吸引治疗的剖宫产瘢痕内生性异位妊娠患者进行术后即时评估,识别高危亚群,并提前选择合适的辅助治疗,特别适用于低收入地区和资源有限的基层医院。