Study On The Improvement And Application Value Of Prenatal Prediction Score Sheet Of Postpartum Hemorrhage

Objectives:The prenatal risk factors of postpartum hemorrhage were discussed,and the prenatal risk scoring system of postpartum hemorrhage was established on the basis of the risk factors,so as to supplement and provide theoretical basis for the prenatal risk factors of the current postpartum hemorrhage prediction model,and its clinical application value was demonstrated through internal verification.Method:This is a retrospective study.A total of 1342 pregnant women who underwent systematic prenatal examination and hospitalized delivery in the Third Affiliated Hospital of Guangzhou Medical University,Nanfang Hospital of Southern Medical University and Dongguan People’s Hospital from January 1,2016 to December 31,2018 were selected,and those who underwent systematic prenatal examination in Nanfang Hospital of Southern Medical University from January 1,2022 to December 31,2022 were selected A total of 450 pregnant women who were hospitalized for delivery were examined,and the research objects were screened according to the inclusion and exclusion criteria,and the case databases of the modeling group and the validation group were constructed,respectively.Based on the screening of prenatal risk factors,an prenatal prediction scoring system for PPH was established,and a clinical prediction model was presented in the form of a score table.The clinical application value was evaluated from the discrimination,calibration,decision curve analysis and comparison of the prediction accuracy of different models.Results:1.Age,BMI in early pregnancy,fetal position,number of fetuses,mode of conception,gravidity,parity,history of abortion,history of macrosomia,history of premature rupture of membranes,history of cesarean section and uterine surgery,history of placenta previa,and pregnancy complicated with abnormal blood glucose were included in the prenatal risk factors of postpartum hemorrhage by univariate analysis.2.Multivariate Logistic regression analysis showed that age,number of fetuses,assisted pregnancy and pregnancy with placenta previa were independent risk factors for postpartum hemorrhage.Finally,11 factors including age,BMI in early pregnancy,gravidity,parity,abortion history,mode of conception,fetal position,number of fetuses,history of premature rupture of membranes,history of cesarean section and uterine surgery,and history of placenta previa were included in the construction of the prenatal risk prediction model of PPH,and the clinical prediction model was presented in the form of a score table.3.The area under the receiver operating characteristic(ROC)curve(AUC)of the clinical prediction model in the modeling cohort and the validation cohort were 0.830 and 0.722 respectively,It is suggested that the clinical prediction model with good discrimination can better distinguish the possibility of postpartum hemorrhage in individuals.The calibration curves drawn by the modeling group and the validation group fitted well with the standard line,indicating that the clinical model predicted the risk of postpartum hemorrhage had a good consistency with the actual risk.In decision curve analysis(DCA),the threshold probability ranges of 0.1-1,0.1-0.85were higher than the two extreme lines,indicating that the model had certain clinical validity.4.The risk of postpartum hemorrhage is significantly increased when the prenatal total score is≥6,the predictive sensitivity was 75.8%,and the specificity was 77.9%.Conclusion:1.The modified prenatal prediction scoring system for PPH incorporates prenatal risk factors more comprehensively,and presents a clinical prediction model in the form of a score table,making the model easier to understand and apply.2.This clinical prediction model performs well in discrimination,calibration and clinical decision curve analysis,and the sensitivity and specificity are significantly better than other predictive scoring systems for postpartum hemorrhage,which has certain clinical application value.In the future,it is necessary to further expand the sample size to enrich and improve the experimental results,modify the original risk prediction model,and improve its clinical prediction accuracy.