凶险性前置胎盘患者髂总球囊预置治疗后并发产后出血的影响因素及预测模型构建

The influencing factors and prediction model of postpartum hemorrhage in patients with placenta previa after preoperative placement of iliac artery balloon catheter

摘要:

目的 分析凶险性前置胎盘患者髂总球囊预置治疗后并发产后出血的影响因素，构建并验证列线图预测模型。方法 回顾性分析淮安市第一人民医院2021年4月—2024年7月诊治的97例凶险性前置胎盘患者的病历资料。所有患者接受髂总球囊预置治疗。根据凶险性前置胎盘患者髂总球囊预置治疗后是否并发产后出血分为并发组13例与非并发组84例。比较两组的临床资料，分析凶险性前置胎盘患者髂总球囊预置治疗后并发产后出血的影响因素，构建并验证列线图预测模型。结果 并发组年龄≥35岁构成比、术前体质量指数（BMI）≥28 kg/m²构成比、流产或引产次数、胎盘植入或粘连构成比、D-二聚体/血小板计数比值（DPR）均高于非并发组（P <0.05）。年龄≥35岁［O^R =3.421（95% CI：1.504，7.783）］、术前BMI ≥28 kg/m² ［O^R =4.433（95% CI：1.949，10.083）］、流产或引产次数多［O^R =3.842（95% CI：1.689，8.740）］、DPR水平高［O^R =4.874（95% CI：2.143，11.088）］均为凶险性前置胎盘患者髂总球囊预置治疗后并发产后出血的危险因素（P <0.05）。列线图模型预测凶险性前置胎盘患者髂总球囊预置治疗后并发产后出血的敏感性为95.31%（95% CI：0.621，0.996），特异性为84.52%（95% CI：0.746，0.912）。结论 年龄、术前BMI、流产或引产次数、DPR与凶险性前置胎盘患者髂总球囊预置治疗后并发产后出血风险有关，构建列线图预测模型有助于早期识别凶险性前置胎盘患者髂总球囊预置治疗后并发产后出血的风险。

Abstract:

Objective To analyze the influencing factors of postpartum hemorrhage in patients with placenta previa after preoperative placement of iliac artery balloon catheter, and construct and validate a nomogram prediction model.Methods The medical records of 97 placenta previa patients from the First People's Hospital of Huaian City from April 2021 to July 2024 were selected for retrospective analysis. All patients were pretreated with common iliac balloon. placenta previa patients were divided into concurrent group (n = 13) and non-concurrent group (n = 84) according to whether postpartum hemorrhage was complicated after pretreatment with common iliac balloon. The clinical data of the two groups were compared to analyze the influencing factors of postpartum hemorrhage after pretreatment with the common iliac balloon in placenta previa patients, and the prediction model of the nomogram was constructed and verified.Results The age ≥ 35 years old, preoperative body mass index (BMI) ≥ 28 kg/m², the rate of placenta accreta or adhesion, the number of miscarriages/induced abortions, and the ratio of D-dimer/platelet ratio(DPR) in the concurrent group were higher than those in the non-concurrent group (P < 0.05). Age ≥ 35 years old [O^R = 3.421 (95% CI: 1.504, 7.783)], preoperative BMI ≥ 28 kg/m² [O^R = 4.433 (95% CI: 1.949, 10.083)], frequent miscarriages/induced abortions [O^R = 3.842 (95% CI: 1.689, 8.740)] and high DPR level [O^R = 4.874 (95% CI: 2.143,11.088)] were both risk factors for postpartum hemorrhage after common iliac balloon preplacement in placenta previa patients (P < 0.05). The sensitivity of the nomogram model in predicting postpartum hemorrhage after common iliac balloon preimplantation treatment in placenta previa patients was 95.31% (95% CI: 0.621, 0.996), and the specificity was 84.52% (95% CI: 0.746, 0.912).Conclusion Age, pre-pregnancy BMI, number of abortions/induced labor, and DPR are associated with the risk of postpartum hemorrhage after treatment with common iliac balloon preset in placenta previa patients. The construction of a nomogram prediction model is helpful for early identification of the risk of postpartum hemorrhage after treatment with common iliac balloon preset in placenta previa patients.