Development and validation of a prognostic nomogram for severe postpartum hemorrhage after cesarean delivery: A two-center retrospective study

IF 2.4 3区医学 Q2 OBSTETRICS & GYNECOLOGY International Journal of Gynecology & Obstetrics Pub Date : 2025-01-13 DOI:10.1002/ijgo.16149

Wanchang Yin, Xinghe Wang, Ruiman Li

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Abstract

Objectives

To develop and validate a nomogram to predict severe postpartum hemorrhage following cesarean delivery.

Methods

This is a two-center retrospective cohort study. Cesarean delivery patients from the First Affiliate Hospital of Jinan University were divided into a development cohort (n = 11 137) and an internal validation cohort (n = 4739). Cesarean delivery patients from the Dongguan Maternal and Child Health Care Hospital (n = 13 775) were enrolled in the external validation cohort. The nomogram was based on independent risk factors for severe postpartum hemorrhage obtained by multivariate logistic regression. We evaluated the discrimination and calibration of the nomogram in the development and validation cohorts.

Results

The nomogram used data including previous cesarean delivery, pre-pregnancy weight, preterm birth, placenta previa, placenta accreta spectrum disorders, placental abruption, and mode of anesthesia. The area under the curves of the nomogram in the internal and external validation cohorts were 0.922 (95% confidence interval [CI] 0.897–0.947) and 0.813 (95% CI 0.785–0.841), respectively. Consistency between the predicted and actual probabilities was observed in both validation cohorts.

Conclusions

The nomogram displayed good calibration and discrimination and can be used for screening in clinical practice to enable clinicians to intervene appropriately.

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剖宫产后严重产后出血预后图的开发和验证：一项双中心回顾性研究。

目的：建立并验证剖宫产后严重产后出血的nomogram预测方法。方法：采用双中心回顾性队列研究。来自暨南大学附属第一医院的剖宫产患者分为发展队列（n = 11 137）和内部验证队列（n = 4739）。来自东莞市妇幼保健院的剖宫产患者（n = 13775）被纳入外部验证队列。经多因素logistic回归，得出严重产后出血的独立危险因素。我们评估了在开发和验证队列中nomogram的鉴别和校准。结果：剖宫产、孕前体重、早产、前置胎盘、胎盘增生谱系障碍、胎盘早剥、麻醉方式等数据均为nomogram。内部验证队列和外部验证队列的曲线下面积分别为0.922（95%可信区间[CI] 0.897 ~ 0.947）和0.813（95%可信区间[CI] 0.785 ~ 0.841）。在两个验证队列中观察到预测概率和实际概率之间的一致性。结论：该图具有良好的校正性和辨别性，可用于临床筛查，使临床医生能够适当干预。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Gynecology & Obstetrics 医学-妇产科学

CiteScore

5.80

自引率

2.60%

发文量

493

审稿时长

3-6 weeks

期刊介绍： The International Journal of Gynecology & Obstetrics publishes articles on all aspects of basic and clinical research in the fields of obstetrics and gynecology and related subjects, with emphasis on matters of worldwide interest.