多次部宫产术后再次妊娠严重产后出血列线图 预测模型的构建

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【中图分类号】R714.7 【文献标志码】A

【AbstractlObjective：Toestablishanomogrampredictionmodelforseverepostpartum hemorrhageinsubsequentpregnanciesafter multiplecesareansections.Methods：Aretrospectiveanalysisaspeforedfortheclinicalandimagingdataof395pregnantandpar turientwomenwithmultiplecesareansectionwhowerehospitalizedfordeliveryfromJanuary2O21toDecember2O23.Univariate analysisandultivaratelogisticregressonaalysiswereusedtoinvestigatetheiskfactorsforsevrepostparummohageiubsequent pregnanciesaftermultiplecesareansections.Anomogrampredictionmodelwas establishedandvalidatedintermsof specificity，accuracyicalsiguilitysultsog95tits，edretp， accounting for 33.16% .The univariate analysis showed thattimes of pregnancy，times of vaginal delivery，gradeof hospitals for previoussurgeries，umberofprenatalchckupsurigthistieofpregancyregnancyducedhpertesio，estatioaldbetes，la centaprevia，locationofplacentasociationetweenplacentaanduterusandwhethermergencycesareansectionwaspfoed were risk factors for severe postpartum hemorhage in subsequent pregnancies after multiple cesarean sections （ P<0.05 ）. The multivariatelogisticregresalysisowedtattisofpregacyumberofpenatalkupsstatioalabes，osiifata andwheteremergencyesareansectionwasperformedwereindependentriskfactorsforseverepostpartumhemorrhageinsubsequent pregnancies after multiple cesarean sections（ P<0.05 ）.A nomogram prediction model was established based on these independent risk factors，which had anareaunder the ROC curve of O.783（95 % CI= 0.732-O.834），and there was a good consistency between the predicted probabilitycurve andthe observed frequencycurve.When theprobability of severe postpartum hemorrhage predicted by the nomogram model waswithin the range of O.15-1.O，the model has a goodvalueof clinical decision-making.Conclusion：The incidence rate of severe postpartum hemorrhage in this population can be reduced by attending regular prenatal checkups，controlling pregnancycomplications，andreducing therateofemergencycesareansectionandthenumberofdeliveries.Thenomogramprediction model established in this study has certain clinical application prospects. 【Key wordsmultiple cesarean sections ;severe postpartum hemorhage ;risk factors;nomogram prediction model

产后出血仍是全球孕产妇死亡的首位原因。（剩余11105字）