Construction And Application On Risk Prediction Model Of Postpartum Urinary Retention In Vaginal Delivery Parturients

BackgroundEarly prevention of postpartum urinary retention(PUR)is essential for vaginal delivery.Pregnancy and childbirth are the underlying causes of postpartum urinary retention.The pathogenesis is not completely clear.The current research focuses on diagnosis and treatment.There is still a lack of early prevention tools for vaginal delivery of PUR.Objectives1.Analyze and identify risk factors that cause PUR in vaginal delivery.2.Based on risk factors,construct and verify the PUR risk prediction model after vaginal delivery,and provide screening tools for PUR high-risk groups after vaginal delivery.3.Using the risk prediction model of vaginal delivery PUR,screening high-risk PUR women,combined with B-B-ultrasound to assess residual urine volume,intervention in high-risk groups,according to the effect of intervention,provide a basis for clinical prevention of PUR interventions for vaginal delivery.Methods1.Case review regression analysis to analyze the risk factors of vaginal delivery PUR.Based on literature search,self-designed PUR risk factors questionnaire for vaginal delivery,retrospective data analysis of maternal vaginal delivery in a maternal and child health care center in Shenzhen from June 2015 to December 2015,analysis of risk factors leading to PUR.2.Construction and verification of PUR risk prediction model after vaginal delivery.Based on the results of retrospective analysis,a prospective study was conducted to select 1048 maternal vaginal delivery patients from a maternal and child health center in Shenzhen from April 2018 to June 2018 to collect general information and related risk factors.The logistic multi-factor regression analysis was used to establish the PUR risk prediction model.The model was internally verified to calculate the average false positive rate and consistency.The R-software was used to construct the nomogram based on the risk prediction model.3.Application of PUR risk prediction model after vaginal deliveryThe women who received vaginal delivery from a tertiary maternal and child health care center in Shenzhen from July 2018 to September 2018 were randomly divided into study group and control group.The control group only gave routine postpartum care to the study group.Immediately after maternal delivery,the PUR predictive model is used to assess the risk of maternal women.The women who are assessed to be at high risk of PUR will be intervened in the early postpartum period.B-B-B-ultrasound monitoring of bladder urine volume will be used to monitor bladder urine volume every 2 hours after birth.Once,the maternal urination was guided according to the amount of bladder urine until 6 hours after delivery,and the incidence of PUR at 24 hours postpartum was evaluated.Results1.Analysis of risk factors for vaginal delivery PUR.From 3256 cases of vaginal delivery,82 cases were screened.The regression analysis showed that the risk factors of PUR in vaginal delivery were:1.Labor time:the most relevant to PUR(OR=15.684,P<0.001)2;epidural anesthesia drug labor analgesia(OR=2.362,P<0.05);3.forceps assisted labor(OR=2.412,P<0.05);4.cervical closure(OR=5.621,P<0.05);5.Oxytocin application(OR = 2.274,P<0.05).2.Construction and verification of risk prediction model for vaginal delivery PUR.The overall incidence of PUR was 8.0%.The constructed predictive model included four factors including labor analgesia,second stage of labor>60 min,perineal cut,and neonatal weight>3.5 kg.The C-statistic was 0.786(95%CI:0.760-0.811).The average misjudgment rate of the model is 8.0%,and there is a good agreement between the model-based prediction probability and the actual probability.(Hosmer-Lemeshow test P = 0.590).3.Application of PUR risk prediction model for vaginal delivery.The study group and the control group,in the labor analgesia,the second stage of labor>60min,instrumental midwifery,labor analgesia,perineal side cut,newborn(body weight>3500g),there was no statistical difference in these high risk factors.The study group evaluated the risk prediction model of vaginal delivery PUR,evaluated patients with high-risk PUR,performed early postpartum intervention,and used B-B-B-ultrasound to monitor intravesical urine volume to guide urination.The average amount of postpartum 2H bleeding was 128.52±7.53 in the study group.Ml,the control group weas 130.95±6.40ml,(P=0.010);the number of postpartum urinary retention was 3 in the study group and 12 in the control group(P=0.013).The incidence of PUR and postpartum hemorrhage in the study group were lower than those in the control group.Conclusion1.Labor time,drug labor analgesia,prenatal delivery,cervical closure and oxytocin application are risk factors for independent PUR in vaginal delivery.2.This study developed a nomogram for PUR risk prediction,which is expected to be an important tool for PUR risk prediction and an important assessment basis for the implementation of post-natal preventive measures.3.Applying the PUR risk prediction model after vaginal delivery,conducting a risk assessment of PUR,and early intervention for high-risk groups can effectively reduce the occurrence of postpartum urinary retention,provide guidance for clinical practice,and further achieve accurate care.