临床误诊误治2025，Vol.38Issue(10)：81-86,6.DOI:10.3969/j.issn.1002-3429.2025.10.013
胎盘植入性疾病患者发生严重产后出血的影响因素及预测模型效能研究
Study on the Influencing Factors of Severe Postpartum Hemorrhage in Pa-tients with Placenta Accreta Spectrum Disorders and the Predictive Effica-cy of Prediction Models
摘要
Abstract
Objective To explore the influencing factors of severe postpartum hemorrhage in patients with placenta accreta spectrum disorders(PAS)and the predictive efficacy of the prediction model based on the influencing factors.Meth-ods The data of 164 patients with PAS admitted to our hospital from January 2022 to January 2024 were retrospectively ana-lyzed.According to the occurrence of severe postpartum hemorrhage(bleeding volume≥1000 mL within 24 h following birth),they were divided into hemorrhage group(n=76,with severe postpartum hemorrhage)and non-hemorrhage group(n=88,without severe postpartum hemorrhage).The general data of the two groups were analyzed by univariate analysis.Bi-nary logistic regression was used to analyze the related factors of severe postpartum hemorrhage in patients with PAS,and a prediction model was constructed,to evaluate its predictive efficacy.Results The type of placenta previa(central type),the relationship between the placenta and myometrium(penetrating implantation),the boundary between the lower segment of the uterus and the placenta(unclear),the hyperechoic decidual interface between the uterine wall and the placenta(disappear-ance),and uterine contraction fatigue were all risk factors for severe postpartum hemorrhage in patients with PAS,while he-moglobin(≥110 g/L)on admission was a protective factor(P＜0.05,P＜0.01).The receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of the prediction model constructed according to the above influencing factors for severe postpartum hemorrhage in patients with PAS was 0.931(95%CI:0.894,0.968),the sensitivi-ty was 78.9%and the specificity was 93.2%.Conclusion The type of placenta previa(central type),the relationship be-tween the placenta and uterine muscle wall(penetrating implantation),the boundary between the lower segment of the uterine muscle layer and the placenta(unclear),the hyperechoic decidual interface between the uterine wall and the placenta(disap-pearance),uterine contraction fatigue,and hemoglobin on admission(≥110 g/L)are all the influencing factors of severe postpartum hemorrhage in patients with PAS.The prediction model constructed based on the above factors has good predictive value.关键词
胎盘植入性疾病/产后出血/严重/预测模型/危险因素/回归模型/干预Key words
Placenta accreta spectrum disorders/Postpartum hemorrhage/Severity/Prediction model/Risk factor/Regression model/Intervention分类
医药卫生引用本文复制引用
张靖霄,张志敏,张家颖,尹鑫,张佳佳,曹翠影..胎盘植入性疾病患者发生严重产后出血的影响因素及预测模型效能研究[J].临床误诊误治,2025,38(10):81-86,6.基金项目
2021年石家庄市科学技术研究与发展自筹计划项目(211461383) （211461383）
河北省医学适用技术跟踪项目(GZ2022080) （GZ2022080）
