Development Of Early Warning Scale For Pregnant Women In The Third Trimester Of Pregnancy

Objective:The purpose of this study was to develop an early warning scale for pregnant women in the third trimester of pregnancy,which was suitable for nurses,and applied it to clinical practice to verify its practicability and effectiveness,and to provide an objective and quantitative basis for the classification and treatment of pregnant women in the third trimester of pregnancy.Methods:1.Based on the literature review and semi-structured interviews,the Delphi method was used to construct an indicator framework for early pregnancy scores in the third trimester of pregnancy.The index classification and scoring were determined using the literature method and the expert meeting method.The analytic hierarchy process was used.Calculate the weight of each index,and perform 85 pre-experiments to delete the index of the score table,and finally form the early warning score for pregnant women during the third trimester.2.A convenient sampling method was used to select 370 pregnant women who were admitted to a Grade 3A hospital from July 2017 to October 2017.The trained nurses or midwives used the developed early warning scale for pregnant women to evaluate their condition.The data were recorded in the software Excel 2010 and the reliability and validity of the scale were tested with the evaluation results.3.The convenience sampling method was used to select 100 pregnant women who were admitted from November 2017 to December 2017 in obstetrics department of a general hospital for the study of potential critical pregnant women in the third trimester of pregnancy.The receiver operating characteristic curve(ROC curve)was drawn to analyze the sensitivity and specificity of the scoring table and to determine the best threshold.Results:1.The effective recovery rate of the two rounds of expert letter inquiry volume was97.78% and 95.45%(>70%)respectively;the authority of experts was 0.927 and 0.936(>0.70)respectively;the coordination coefficient of expert opinion was 0.158 and 0.297,respectively.After the round of expert consultation,the index coefficient of variation ranged from 0.07 to 0.20.The five primary indicators and weights were: general condition(0.1384),symptom(0.0954),physical sign(0.1831),check(0.3409),and test(0.2422).In the end,five first-level indicators and 24 second-level indicators of early pregnancy warning scores for pregnant women were formed.2.Applying the early warning scale to the evaluation of 370 pregnant women with potential critical pregnancy in the third trimester of pregnancy,the results showed that the overall Cronbach ? coefficient,split-half Spearman-Brown coefficient,Theta coefficient(?)and Omega coefficient(?)were 0.537,0.540,0.760 and 0.638,The inter-person reliability was 0.978.In terms of validity,the content validity index(I-CVI)of each indicator ranges from 0.8 to 1.0,and the S-CVI of the score table is 0.975.The results of exploratory factor analysis showed that 8 common factors were extracted,the cumulative contribution rate was 56.562,and the load of each index factor was 0.335-0.915.3.The area under the ROC curve of the Early Warning Scale was 0.869 with a 95%confidence interval(0.793-0.945).the best threshold is 10.317.At this time,the sensitivity,specificity and Yorden index of the early warning scoring scale were 0.82,0.88,0.70.Conclusion:The positive coefficient,the degree of authority and the coordination coefficient of the expert letter prove that the expert consultation has a high credibility,and the indexes of the early warning scoring table have good weight coefficient.The reliability and validity of the scale were verified by actual test,and it had high sensitivity and specificity for critically ill pregnant women during late pregnancy.The early warning scale could reflect the health status of the pregnant women in the third trimester.To provide the basis for the evaluation of the condition of pregnant women in the third trimester,and help to identify the critical pregnant women.