摘要
目的探究高龄二胎阴道分娩产妇产后大出血的风险因素,并构建风险预警模型,以评估产后大出血风险。方法选择本院2017年1月—2021年2月收治的180例高龄二胎阴道分娩产妇为研究对象,以2017年1月—2020年1月收治的120例高龄二胎阴道分娩产妇为构建组,以2020年2月—2021年2月收治的60例高龄二胎阴道分娩产妇为验证组,采用一般资料调查表调查患者的相关资料,统计构建组产妇发生产后大出血的例数,通过单因素分析、多因素logistic回归分析筛选高龄二胎阴道分娩产妇产后大出血的独立风险因素,并基于回归分析法建立产后大出血的风险预警模型,评估其在验证组中的应用效果。结果构建组中发生产后大出血的高龄二胎阴道分娩产妇共41例(34.17%),孕次≥3次、妊娠期高血压、新生儿体重>4 kg、前置胎盘、宫缩乏力是高龄二胎阴道分娩产妇产后大出血的独立风险因素;根据预警模型,可将产后大出血风险分为3级,包括低风险、中风险、高风险;ROC曲线分析显示,曲线下面积为0.841;风险预警模型应用结果显示,该模型的灵敏度为87.50%,特异度为90.91%,准确率为90.00%。结论高龄二胎阴道分娩产妇存在产后大出血的风险,且独立风险因素较为复杂,研究构建的产后大出血风险预警模型的灵敏度、特异度均较高,能实现对产后大出血的准确预测。
Objective To explore the risk factors of postpartum massive hemorrhage in elderly women with vaginal delivery of second child,and to construct a risk warning model to evaluate the risk of postpartum massive hemorrhage.Methods A total of 180 elderly women with vaginal delivery of second child admitted to our hospital from January 2017 to February 2021 were selected as the research objects.120 elderly women with vaginal delivery of second child admitted to our hospital from January 2017 to January 2020 were selected as the construction group,and 60 elderly women with vaginal delivery of second child admitted to our hospital from February 2020 to February 2021 were selected as the validation group.By general information questionnaire survey in patients with relevant data,statistics to build group of maternal postpartum hemorrhage cases,through the single factor analysis,multiple factors logistic regression analysis to screen-second child vaginal delivery women independent risk factors of postpartum hemorrhage,and based on the regression analysis method to establish the risk early warning model of postpartum hemorrhage,evaluate the effectiveness of its application in the validation group.Results In the construction group,there were 41 cases(34.17%)of older women with vaginal delivery of second child who had postpartum massive hemorrhage.The number of pregnancy(greater than or equal to 3 gestation times),gestational hypertension,neonatal weight(greater than 4 kg),placenta previa,uterine weakness are independent risk factors for postpartum hemorrhage in women with vaginal delivery of second child in advanced age.According to the warning model,the risk of postpartum major hemorrhage can be divided into three levels,including low risk,medium risk and high risk.ROC curve analysis showed that the area under the curve was 0.841.The application results of the risk warning model show that the sensitivity,specificity and accuracy of the model are 87.50%,90.91%and 90.00%,respectively.Conclusion Elderly women with vaginal delivery of second child are at risk of postpartum massive hemorrhage,and the independent risk factors are complex.The risk warning model of postpartum massive hemorrhage constructed in this study has high sensitivity and specificity,which can achieve accurate prediction of postpartum massive hemorrhage.
作者
黄悦琴
钟红珠
苏钰纯
HUANG Yueqin;ZHONG Hongzhu;SU Yuchun(Department of Obstetrics and Gynecology,The Second People′s Hospital of Shantou,Guangdong Province,Shantou 515011,China)
关键词
高龄产妇
二胎
阴道分娩
产后出血
风险预警
Senile parturients
Second child
Vaginal delivery
Postpartum hemorrhage
Risk warning
