Establishment of a nomogram prediction model for severe postpartum hemorrhage in subsequent pregnancies after multiple cesarean sections
10.13406/j.cnki.cyxb.003923
- VernacularTitle:多次剖宫产术后再次妊娠严重产后出血列线图预测模型的构建
- Author:
Xia DU
1
;
Qi WU
;
Jiarui LI
;
Cheng CHEN
Author Information
1. 重庆医科大学/重庆市人民医院妇产科,重庆 401146
- Keywords:
multiple cesarean sections;
severe postpartum hemorrhage;
risk factors;
nomogram prediction model
- From:
Journal of Chongqing Medical University
2025;50(10):1426-1433
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To establish a nomogram prediction model for severe postpartum hemorrhage in subsequent pregnancies after multiple cesarean sections.Methods:A retrospective analysis was performed for the clinical and imaging data of 395 pregnant and par-turient women with multiple cesarean section who were hospitalized for delivery from January 2021 to December 2023.Univariate analysis and multivariate logistic regression analysis were used to investigate the risk factors for severe postpartum hemorrhage in sub-sequent pregnancies after multiple cesarean sections.A nomogram prediction model was established and validated in terms of specific-ity,accuracy,and clinical decision-making utility.Results:Among the 395 patients,131 experienced severe postpartum hemorrhage,accounting for 33.16%.The univariate analysis showed that times of pregnancy,times of vaginal delivery,grade of hospitals for previ-ous surgeries,number of prenatal checkups during this time of pregnancy,pregnancy-induced hypertension,gestational diabetes,pla-centa previa,location of placenta,association between placenta and uterus,and whether emergency cesarean section was performed were risk factors for severe postpartum hemorrhage in subsequent pregnancies after multiple cesarean sections(P<0.05).The multivari-ate logistic regression analysis showed that times of pregnancy,number of prenatal checkups,gestational diabetes,position of placenta,and whether emergency cesarean section was performed were independent risk factors for severe postpartum hemorrhage in subsequent pregnancies after multiple cesarean sections(P<0.05).A nomogram prediction model was established based on these independent risk factors,which had an area under the ROC curve of 0.783(95%CI=0.732-0.834),and there was a good consistency between the pre-dicted probability curve and the observed frequency curve.When the probability of severe postpartum hemorrhage predicted by the nomogram model was within the range of 0.15-1.0,the model has a good value of clinical decision-making.Conclusion:The incidence rate of severe postpartum hemorrhage in this population can be re-duced by attending regular prenatal checkups,controlling preg-nancy complications,and reducing the rate of emergency cesarean section and the number of deliveries.The nomogram prediction model established in this study has certain clinical application prospects.
