| 王琦雯,杨微微,郑美佳.瘢痕子宫再次妊娠孕妇发生并发症风险的列线图模型建立和评估[J].浙江中西医结合杂志,2023,33(2): |
| 瘢痕子宫再次妊娠孕妇发生并发症风险的列线图模型建立和评估 |
| Establishment and evaluation of a nomogram model for the risk of complications in regnant women with scar uterus second pregnancy |
| 投稿时间：2022-03-09 修订日期：2022-05-04 |
| DOI： |
| 中文关键词: 瘢痕子宫再次妊娠 并发症风险 影响因素 列线图 |
| 英文关键词:pregnant with scar uterus second pregnancy risk of complications influence factor nomogram |
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| 中文摘要: |
| 目的：通过分析瘢痕子宫再次妊娠孕妇发生并发症风险的相关因素，建立和评估预测瘢痕子宫再次妊娠孕妇发生并发症风险的列线图模型。方法：选择2020年1月至2022年1月湖州市妇幼保健院收治的413例瘢痕子宫再次妊娠孕妇作为研究对象，利用单因素与多因素Logistic回归分析筛选出影响发生并发症风险的因素，构建回归方程，依此为基础建立预测瘢痕子宫再次妊娠孕妇发生并发症风险的列线图模型；并评估列线图模型的区分度和准确度。结果：413例瘢痕子宫再次妊娠孕妇中135例发生并发症，总发生率为32.69%；单因素分析结果显示，并发症组和无并发症组在年龄、剖宫产次数、再次妊娠间隔时间、子宫下段切口厚度、子宫切口选择、胎儿、胎盘附着部位、前次切口甲级愈合方面差异有统计学意义（P＜0.05）；多因素Logistic回归分析显示，剖宫产次数≥2次、再次妊娠间隔时间＜2年或＞3年、子宫下段切口厚度≤1.5 mm、子宫下段纵切口、胎盘附着瘢痕处为影响瘢痕子宫再次妊娠发生并发症的独立危险因素（P＜0.05），前次切口甲级愈合为保护性因素（P＜0.05）；采用受试者工作特征曲线评估列线图模型区分度，得到曲线下面积为0.756；校准曲线为斜率接近1的直线，Hosmer-Lemeshow拟合优度检验，=8.675，P=0.370。结论：本研究基于瘢痕子宫再次妊娠孕妇发生并发症风险的影响因素即剖宫产次数、再次妊娠间隔时间、子宫下段切口厚度、子宫切口选择、胎盘附着部位、前次切口甲级愈合绘制的列线图预测模型，具有良好的区分度与准确度，可为瘢痕子宫再次妊娠孕妇并发症的防治提供一定参考价值。 |
| 英文摘要: |
| Objective: By analyzing the related factors of the risk of complications in pregnant women with scar uterus second pregnancy, a nomogram model for predicting the risk of complications in pregnant women with scar uterus second pregnancy was established and evaluated. Methods: 413 pregnant women with scar uterus second pregnancy who were treated in Huzhou maternal and child health hospital from January 2020 to January 2022 were selected as the research objects, the factors affecting the risk of complications were selected by univariate and multivariate logistic regression analysis, and the regression equation was constructed, based on this, a nomogram model was established to predict the risk of complications in pregnant women with scar uterus second pregnancy; the discrimination and accuracy of nomogram model are evaluated. Results: Among 413 pregnant women with scar uterus second pregnancy, 135 had complications, and the total incidence was 32.69%; univariate analysis showed that there were significant differences between the complication group and the non complication group in age, number of cesarean section, interval between pregnancies, incision thickness of lower uterine segment, uterine incision selection, fetus, placental attachment site, grade a healing of previous incision (P<0.05); multivariate logistic regression analysis showed that the number of cesarean sections≥2 times, the interval between pregnancies < 2 years or > 3 years, the thickness of lower uterine incision≤1.5 mm, the longitudinal incision of lower uterine segment and the placental attachment scar were the independent risk factors affecting the complications of second pregnancy of scar uterus (P<0.05), and the grade a healing of the previous incision was the protective factor (P<0.05); receiver operating characteristic curve was used to evaluate the discrimination of nomogram model, and the area under the curve was 0.756; the calibration curve was a straight line with slope close to 1, and Hosmer-Lemeshow goodness-of-fit test showed that =8.675, P= 0.370. Conclusions: In this study, the the prediction model of nomogram based on the influencing factors of complications in pregnant women with scar uterus second pregnancy, such as number of cesarean section, interval between pregnancies, the thickness of lower uterine incision, choice of uterine incision, placental attachment site and grade a healing of the previous incision, has good discrimination and accuracy, which can provide some reference value for the prevention and treatment of complications of pregnant women with cicatricial uterus. |
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