Data_Sheet_4_Development and Validation of Prognostic Nomogram for Postpartum Hemorrhage After Vaginal Delivery: A Retrospective Cohort Study in China.PDF

BackgroundPostpartum hemorrhage (PPH) is a common complication following vaginal delivery and in severe cases can lead to maternal death. A straightforward predictive model is required to enable prenatal evaluations by obstetricians to prevent PPH complications.
MethodsData of patients who delivered vaginally after 37 weeks of gestation were retrospectively collected from the medical database at Shengjing Hospital of China Medical University for the period 2016 to 2020. PPH was defined as blood loss of 500 mL or more within 24 h of delivery, and important independent prognostic factors were determined using univariate and multivariate logistic regression analyses to construct nomograms regarding PPH.
ResultsA total of 24,833 patients who delivered vaginally were included in this study. The training cohort included 22,302 patients who delivered between 2016 and 2019 and the external validation cohort included 2,531 patients who delivered during 2020. Nomogram was created using data such as age, race, occupation, parity, gestational weeks, labor time, neonatal weight, analgesic delivery, gestational diabetes mellitus, premature rupture of membranes, anemia, hypertension, adenomyosis, and placental adhesion. The nomogram has good predictive power and clinical practicality through the analysis of the area under the curve and decision curve analysis. Internal verification was performed on the nomogram for PPH, demonstrating consistency between the nomogram's predicted probability and actual probability.
ConclusionsThe developed and validatable nomogram is a good predictor of PPH in vaginal delivery and can be used in clinical practice to guide obstetricians to administer preventive therapies before delivery.

背景：产后出血（Postpartum hemorrhage, PPH）是阴道分娩后常见的并发症，重症可导致产妇死亡。目前亟需一款简便易用的预测模型，以供产科医师开展产前评估，从而预防产后出血相关并发症。
方法：本研究回顾性收集了2016至2020年中国医科大学附属盛京医院医学数据库中，妊娠37周后经阴道分娩患者的临床资料。本研究将产后出血定义为分娩后24小时内失血量≥500mL，通过单因素及多因素logistic回归分析筛选重要的独立预后因素，以此构建产后出血列线图（nomogram）。
结果：本研究共纳入24833例阴道分娩患者，其中训练队列（training cohort）纳入2016至2019年分娩的22302例患者，外部验证队列（external validation cohort）纳入2020年分娩的2531例患者。本研究基于患者年龄、种族、职业、产次、孕周、产程时长、新生儿体重、分娩镇痛、妊娠期糖尿病（gestational diabetes mellitus）、胎膜早破（premature rupture of membranes）、贫血、高血压、子宫腺肌病及胎盘粘连等数据构建列线图。通过受试者工作特征曲线下面积（area under the curve, AUC）分析及决策曲线分析（decision curve analysis）结果显示，该列线图具有良好的预测效能与临床实用性。对该产后出血列线图进行内部验证，结果表明模型预测概率与实际发生概率具有良好的一致性。
结论：本研究构建并验证的列线图可有效预测阴道分娩患者发生产后出血的风险，可应用于临床实践，指导产科医师在分娩前实施预防性干预措施。