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中华产科急救电子杂志 ›› 2022, Vol. 11 ›› Issue (02) : 99 -104. doi: 10.3877/cma.j.issn.2095-3259.2022.02.007

论著

改良产后出血预测评分表在阴道分娩中的预测价值
李刚辉1, 韩振艳2, 张媛2, 白小艺2, 吴玲玲2, 侯红瑛2,()   
  1. 1. 中山大学附属第三医院产科,广州 510630;西藏民族大学附属医院妇产科,陕西咸阳 712082
    2. 中山大学附属第三医院产科,广州 510630
  • 收稿日期:2021-12-08 出版日期:2022-05-18
  • 通信作者: 侯红瑛

Prediction Value of A Modified Scoring Table of Postpartum Hemorrhage (PPH) in Vaginal Delivery

Ganghui Li1, Zhenyan Han2, Yuan Zhang2, Xiaoyi Bai2, Lingling Wu2, Hongying Hou2,()   

  1. 1. Department of Obstetrics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China; Obstetrics and Gynecology Department, The Affiliated Hospital of Xizang Minzu University, Xianyang 712082, China
    2. Department of Obstetrics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2021-12-08 Published:2022-05-18
  • Corresponding author: Hongying Hou
引用本文:

李刚辉, 韩振艳, 张媛, 白小艺, 吴玲玲, 侯红瑛. 改良产后出血预测评分表在阴道分娩中的预测价值[J/OL]. 中华产科急救电子杂志, 2022, 11(02): 99-104.

Ganghui Li, Zhenyan Han, Yuan Zhang, Xiaoyi Bai, Lingling Wu, Hongying Hou. Prediction Value of A Modified Scoring Table of Postpartum Hemorrhage (PPH) in Vaginal Delivery[J/OL]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2022, 11(02): 99-104.

目的

探讨产后出血高危因素及改良产后出血预测评分表在阴道分娩中的预测价值。

方法

回顾性分析2017年12月至2018年5月在中山大学附属第三医院产科行阴道分娩并纳入研究的产妇616例,根据是否发生产后出血分为研究组(36例)和对照组(580例),收集两组患者的产前、产时及产后资料,使用Logistic回归筛选危险因素;运用改良产后出血预测评分表对产后出血各高危因素进行评估,计算产前、产时、产后各阶段评分及总评分,计算并比较两组各阶段评分及总评分预测产后出血的ROC曲线下面积。

结果

两组患者在产程时长是否正常(aOR=3.12,95%CI:1.14~8.50)、是否自然临产(aOR=2.57,95%CI:1.05~6.30)、产后进食少(aOR=12.27,95%CI:2.52~58.82)方面的比较,P值均<0.05。总评分对产后出血预测效果最好,ROC曲线下面积为0.734(0.697~0.768)。当总评分≥5分时,预测产后出血的敏感度为77.78%,特异度为57.93%。

结论

产程异常、人工引产、产后进食少是产后出血的独立危险因素。改良的产后出血预测评估表具有良好的预测效果。

Objective

To investigate the utility of a modified scoring table of PPH in women succeeding in vaginal delivery.

Methods

A retrospective study was conducted in 616 pregnant women who had vaginal birth in the Third Affiliated Hospital of Sun Yat-sen University from December 2017 to May 2018. According to whether postpartum bleeding occurred, it was divided into a study group (36 pregnant) and a control group (580 pregnant). A modified scoring table was applied to investigate individual risk factors and scores of PPH. Multivariate logistic regression was performed to screen the risk factors of PPH. The area under the receiver operating characteristic curve and 95% confidence intervals (95%CI) were calculated and compared within different scores.

Results

Major independent risk factors of PPH were abnormal labor, induction of labor and little postpartum food intake, and aOR and 95%CI were 3.12 (1.14~8.50)、2.57 (1.05~6.30)、12.27 (2.52~58.82) respectively. The total score was the best predictor of PPH, with AUC 0.734(0.697~0.768). The optimal cut-off was 5, with a sensitivity of 77.78% and a specificity of 57.93%.

Conclusions

Abnormal labor, induction of labor and little postpartum food intake were independent risk factors of PPH. Our modified scoring table of PPH had reasonably well prediction performance.

表1 改良产后出血预测评分表
表2 研究组与对照组产前高危因素的单因素分析[例(%)]
表3 研究组与对照组产时高危因素的单因素分析[例(%)]
表4 研究组与对照组各阶段评分分值和总评分的单因素分析[例(%)]
表5 产后出血危险因素的Logistic回归分析
图1 产前、产时、产后各阶段产后出血预测ROC曲线图
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