| Objective:To observe the severe adverse pregnancy outcomes in neonates with preterm premature rupture of membranes(PPROM),to explore the risk factors,and to establish a model of neonatal prognosis score for PPROM,and to further validate the model,in order to provide theoretical basis for early risk assessment and intervention of preterm premature rupture of membranes in the future.Methods:By consulting the electronic medical record system of Shengjing Hospital,clinical data were collected from 429 patients with preterm premature rupture of membranes who met inclusion and exclusion criteria for delivery between March 2015 and May 2022,including age,history of abortion,times of pregnancy,uterine fibroids,gestational weeks of delivery,multiple births,fetal position,mode of delivery,scarred uterus,pre-delivery imaging results,pre-delivery test results,etc.,according to the admission time,the model population was divided into model population and validation population.In the model population,the above factors were screened by univariate analysis and multivariate Logistic regression analysis,and the clinical prediction model of adverse pregnancy outcome of premature rupture of membranes newborns was established,the model was evaluated in the modeling population and the validation population,and then the clinical prediction model was displayed in the form of nomograms.Results:There were 345 cases in the model population and 84 cases in the validation population.The incidence of adverse pregnancy outcomes in preterm premature rupture of membranes newborns was 62.9% and 65.5%,respectively,there was no significant difference between the two groups(P=0.660).Univariate analysis showed that Assisted reproductive technology rate(P=0.024),gestational age at delivery(P<0.001),multiple births(P=0.001),depth of amniotic fluid(P=0.032),width of platelet distribution(P=0.018),interleukin-6(P=0.017),c-reactive protein(P=0.033)were statistically significant.Multivariate Logistic regression analysis further screened out four factors including gestational age at delivery(OR=2.80,95% CI:2.06-3.80),multiple births(OR=2.88,95% CI:1.31-6.93),interleukin-6(OR=1.69,95% CI:0.96-3.04),Cesareansection(OR=0.65,95% CI:0.39-1.08),the model is displayed in the form of nomograms.The area under the curve(AUC)of ROC was 0.764 and 0.797 in the modeling set and the validation set respectively,which indicated that the model had good discrimination ability and enough discrimination ability Draw the calibration curve in the modeling set and in the validation set,it is suggested that the system of clinical prediction model can predict the occurrence probability and actual occurrence probability of adverse pregnancy outcome of preterm premature rupture of membranes,the P values of the model set and the validation set were 0.912 and 0.912 respectively,which indicated that the clinical prediction model was effective,and the clinical decision curve(DCA)was drawn in the model set and the validation set,respectively,these results suggest that the model has some clinical validity.The probability of adverse pregnancy outcomes in neonates predicted by this clinical model for preterm premature rupture of membranes≤40% was defined as low risk,the probability of occurrence between 40%and 70% was defined as intermediate risk,and the probability of occurrence≥70% was defined as high risk,the difference was statistically significant(P<0.05).Conclusions:Gestational age and multiple births are independent risk factors for severe adverse pregnancy outcomes in neonates with preterm premature rupture of membranes.A risk prediction model with good discrimination,calibration and clinical applicability was established by using gestational age,multiple birth,Interleukin-6 and mode of delivery as predictive factors,on the basis of nomogram,we divided the severe adverse pregnancy outcomes of preterm premature rupture of membranes newborns into low,middle and high risk groups,which has important guiding significance for making diagnosis and treatment measures. |
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