Study On The Establishment Of Prediction Model For Adverse Pregnancy Outcomes In Early Onset Preeclampsia

Preeclampsia(PE) seriously affects maternal and fetal safety.It’s a global disease.PE includes early onset preeclampsia(EOPE)and late onset preeclampsia(LOPE),depending on whether the onset is older than 34 weeks.Compared with LOPE,patients with EOPE showed more maternal and fetal malignant outcomes.The most effective treatment for EOPE is delivery。However,premature delivery may increase the risk of perinatal complications and medical burden due to the early onset time of EOPE and the immature development of fetus.If the expectant management continues,the fetus can be given intrauterine development time,but the disease progression of EOPE patients may increase the risk of perinatal malignant outcome of the mother.How to evaluate the condition of EOPE patients and choose the time of delivery to ensure the maximum benefit of the mother and fetus has always been an unavoidable problem for perinatal workers.At present,there are few studies on the prediction model of adverse pregnancy outcome in EOPE patients in Chinese.BackgroundThis study aims to establish a Nomogram model for prenatal risk assessment by analyzing the risk factors for adverse pregnancy outcomes in EOPE patients,and to provide reference for perinatologists to make clinical decisions.MethodsA total of 299 EOPE cases were collected retrospectively.They are from Qilu Hospital of Shandong University.The review time is from January 2018 to July 2020.The main contents include the basic information of patients(age,partus,etc.),complications of pregnancy,clinical symptoms and auxiliary examination results.The outcome indicators of EOPE women mainly include:eclampsia,cerebrovascular accident,placental abruption,heart failure.HELLP syndrome,liver function injury,postpartum hemorrhage,acute renal injury,retinal detachment,pulmonary edema,DIC,maternal death.EOPE patients were divided into modeling group and verification group.In the modeling group,214 patients with EOPE were hospitalized and delivered from January 2018 to July 2019;The verification group included 85 patients with EOPE who were hospitalized and delivered from August 2019 to July 2020.The clinical information of two groups of EOPE patients were compared,and the adverse pregnancy outcomes of EOPE women were counted.Univariate and multivariate regression logic analyses were performed in the modeling group to identify independent predictors of adverse pregnancy outcomes in mothers of EOPE patients.Based on this,establishe a Nomogram prediction model.R software completes this process.Receiver operating characteristic(ROC)curve was used to evaluate the ability of the model to distinguish the adverse prognosis of EOPE patients.Through the validation group data for internal validation.ResultsOf the 299 EOPE cases,69(23.1%)had a malignant pregnancy outcome.This number was 54 in the modeling group and 15 in the validation group.This was not statistically significant.The most common adverse pregnancy outcome was placental abruption,with 30 cases(10%).Then there were 15 cases of heart failure(5%),14 patients of HELLP syndrome(4.7%),8 cases of liver function impairment(2.7%).There were 4 patients with postpartum hemorrhage,accounting for 1.3%.The number of acute kidney injury(AKI)was 4(1.3%).2(0.7%)EOPE women complicated with retinal detachment.There was only one woman of pulmonary edema,accounting for 0.3%.So was DIC.No maternal death,no eclampsia and cerebrovascular accident.Nine of the patients had two or more adverse pregnancy outcome indicators.Through univariate regression logic analysis of adverse pregnancy outcomes in EOPE patients in the modeling group,we identified 15 potential risk factors(P<0.15)associated with adverse pregnancy outcomes,which were:Hospital stay before delivery.Assisted reproductive techniques,Chronic hypertension,Epigastric pain.Chest tightness and Asthma.Edema,Alanine aminotransferase,Prothrombin time,Creatinine,D-dimer,Heterotopic heart rate,Aspartate aminotransferase,Platelet,Fibrinogen,Hemoglobin.According to these factors,the multivariate regression analysis was carried out.Five independent high-risk predictors of malignant pregnancy ending in women with EOPE were reached(P<0.05).They were chest tightness and asthma symptoms,chronic hypertension,elevated alanine aminotransferase,decreased platelet count,elevated D-dimer.Therefore,the Nomogram prediction model was established using R software.In the modeling group,the area under the curve(AUC)was 0.75.In the validation group,the AUC value of the prediction model obtained is 0.63.It is suggested that the model has a good clinical prediction value,for EOPE patients.Conclusions1.EOPE patients have a higher risk of adverse maternal pregnancy outcomes.Placental abruption,heart failure,HELLP syndrome is a common complication of EOPE pregnant women.2.Chest tightness and asthma,chronic hypertension,elevated alanine aminotransferase,decreased platelet count and elevated D-dimer were independent risk factors for adverse pregnancy outcomes in EOPE patients.3.This study has established a Nnomogram prediction model for the prenatal risk of adverse pregnancy outcomes in EOPE patients,which has good predictive value.And the selected indicators are easy to obtain.So that clinicians can evaluate the condition of EOPE patients more objectively and quantitatively,and it has some clinical guidance value for selecting the appropriate delivery time and providing the best treatment plan.