Clinical value of scoring system of postpartum hemorrhage in predicting postpartum hemorrhage in pregnant women of different ages
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摘要:
目的 分析在不同年龄阶段孕妇中产后出血高危评分系统对产后出血(PPH)的预测价值，为个性化评估PPH风险提供参考。 方法 选择2019年5月—2022年5月于温州市中西医结合医院产科住院分娩的3 559例孕妇作为研究对象。按年龄和孕妇是否诊断为PPH分为PPH组(＜35岁)22例，对照组(＜35岁)44例；PPH(≥35岁)76例，对照组(≥35岁)152例。于入院时、分娩时及分娩后利用产后出血高危评分系统进行评分。分析产后出血高危评分系统在年龄＜35岁与≥35岁的孕妇中的预测价值。 结果 产前评分、产时产后评分及总评分对PPH均具有预测效能(P≤0.001)，曲线下面积(AUC)分别为0.703、0.796、0.806。PPH组(＜35岁)孕妇产前评分、产时产后评分、总分评分均明显高于对照组(＜35岁，均P＜0.05)；PPH组(≥35岁)孕妇产前评分、产时产后评分、总分评分均明显高于对照组(≥35岁，均P＜0.05)。在年龄＜35岁孕妇中，产时产后评分及总评分对PPH具有预测价值(P＜0.001)，AUC为0.785、0.839，最佳截断值为4、10分，产前评分对PPH不具有预测价值(P＞0.05)。在年龄≥35岁孕妇中，产前评分及总评分对PPH具有预测价值(P＜0.001)，AUC为0.786、0.881，最佳截断值为6、7分，产时、产后评分对PPH不具有预测价值(均P＞0.05)。 结论 产后出血高危评分系统对PPH具有较好的预测效能。在＜35岁与≥35岁的孕妇中评分的截断值有所不同。 Abstract:Objective To analyze the predictive value of scoring system of postpartum hemorrhage (PPH) in pregnant women of different ages, and provide reference for personalized assessment of PPH risk. Methods A total of 3 559 pregnant women who gave birth in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from May 2019 to May 2022 were selected as subjects. According to age and whether the pregnant women were diagnosed with PPH, they were divided into PPH group (< 35 years old, 22 cases; ≥35 years old, 76 cases) and control group (< 35 years old, 44 cases; ≥35 years old, 152 cases). The scoring system of PPH was used to score pregnant women at admission, delivery and after delivery. The predictive value of scoring system of PPH in pregnant women aged < 35 years versus ≥35 years was analyzed. Results Prenatal score, postpartum score and total score all had predictive effects on PPH (P≤0.001), and area under curve (AUC) were 0.703, 0.796 and 0.806, respectively. The prenatal score, postpartum score and total score of pregnant women in PPH group (< 35 years old) were significantly higher than those in control group (< 35 years old, all P < 0.05). The prenatal score, postpartum score and total score of pregnant women in PPH group (≥35 years old) were significantly higher than those in control group (≥35 years old, all P < 0.05). In pregnant women < 35 years old, postpartum score and total score had predictive value for PPH (P < 0.001), AUC were 0.785 and 0.839, and the optimal cut-off value were 4 and 10 points, while prenatal score had no predictive value for PPH (P>0.05). In pregnant women age ≥35 years, prenatal score and total score had predictive value for PPH (P < 0.001), AUC were 0.786 and 0.881, and the optimal cut-off value were 6 and 7 points, while postpartum score had no predictive value for PPH (all P>0.05). Conclusion Scoring system of PPH has a good predictive effect on PPH. The cut-off values of the scores are different for pregnant women < 35 years old and ≥35 years old. -
Key words:
- Postpartum hemorrhage /
- Scoring system /
- High risk factors /
- Age
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图 1 产后出血高危因素评分预测PPH的ROC曲线
Figure 1. ROC curve of PPH prediction by postpartum hemorrhage risk factor score
图 2 产后出血高危因素评分预测不同年龄阶段孕妇PPH的ROC曲线
注：A为年龄＜35岁孕妇ROC曲线；B为年龄≥35岁孕妇ROC曲线。
Figure 2. ROC curve of PPH prediction by postpartum hemorrhage risk factor score in pregnant women of different ages
表 1 产后出血高危评分系统
Table 1. Scoring system for postpartum hemorrhage risk
变量 评分(分) 0 1 2 3 产前评分 年龄(岁) 20~34 ＜20或≥35 ≥40 人工流产史(次) 无 1 2 3及以上 产次(次) 0或1 2 3或4 5及以上 孕早期BMI ＜24 ≥24 ≥28 产前宫底高度(cm) ＜32 ≥32 ≥35 ≥40 胎数(胎) 1 ≥2 产前PLT(×109/L) ≥80 ＜80 ＜50 ＜20 前置胎盘 无 边缘性 部分性 完全性 妊娠期高血压疾病 无 妊娠期高血压 轻度子痫前期 重度子痫前期或子痫 妊娠合并子宫肌瘤 无 单发(直径≥3 cm) 多发 胎儿腹围(cm) 正常 ＞正常 羊水过多 无 有 产时、产后评分 分娩方式 自然分娩 阴道助产 剖宫产 子宫切口延裂 无 有 产道裂伤 无 有 第一产程 正常 潜伏期延长活跃期延长 活跃期停滞 第三产程(min) ＜10 10~14 ≥15 ≥20 胎盘粘连或植入 无 有 新生儿体重(g) ＜4 000 ≥4 000 
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表 2 产后出血高危因素评分对PPH的预测价值
Table 2. Predictive value of postpartum hemorrhage risk factor score on PPH
变量 AUC 截断值(分) 灵敏度(%) 特异性(%) P值 95% CI 产前评分 0.703 6 59.5 69.8 0.001 0.591~0.814 产时产后评分 0.796 3 61.3 63.8 ＜0.001 0.701~0.892 总评分 0.806 8 70.5 72.3 ＜0.001 0.716~0.896
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表 3 不同年龄阶段组孕妇一般资料比较(x ± s)
Table 3. Comparison of general data of pregnant women in different age groups
组别 例数 年龄(岁) 孕周 组别 例数 年龄(岁) 孕周 PPH组(＜35岁) 22 29.3±6.6 39.5±2.8 PPH组(≥35岁) 76 38.9±7.5 39.4±3.7 对照组(＜35岁) 44 28.4±5.9 39.2±3.1 对照组(≥35岁) 152 37.3±8.4 39.1±2.5 t值 0.561 0.382 t值 1.404 0.638 P值 0.577 0.704 P值 0.162 0.525
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表 4 不同年龄阶段分组孕妇产后出血高危因素评分比较(x ± s，分)
Table 4. Comparison of scores of high-risk factors for postpartum hemorrhage in different age groups(x ± s, points)
组别 例数 产前评分 产时产后评分 总评分 组别 例数 产前评分 产时产后评分 总评分 PPH组(＜35岁) 22 3.1±2.0 3.6±1.5 7.2±1.6 PPH组(≥35岁) 76 4.3±1.7 3.0±0.8 6.5±1.1 对照组(＜35岁) 44 1.9±0.7 1.8±0.3 3.1±0.8 对照组(≥35岁) 152 2.5±0.9 2.7±1.2 4.5±1.3 t值 2.732 8.669 11.332 t值 8.645 2.803 11.507 P值 0.012 ＜0.001 ＜0.001 P值 ＜0.001 0.006 ＜0.001
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表 5 产后出血高危因素评分对不同年龄阶段孕妇PPH的预测效能
Table 5. Prediction efficacy of postpartum hemorrhage risk factor scores on PPH of pregnant women at different ages
变量 AUC 截断值 灵敏度(%) 特异性(%) P值 95% CI ＜35岁 产前评分 0.523 0.702 0.404~0.643 产时产后评分 0.785 4 69.3 68.7 ＜0.001 0.689~0.881 总评分 0.859 9 72.5 75.8 ＜0.001 0.753~0.924 ≥35岁 产前评分 0.786 6 80.3 76.2 ＜0.001 0.690~0.881 产时产后评分 0.568 0.259 0.447~0.690 总评分 0.881 7 79.8 85.4 ＜0.001 0.714~0.909
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