| Objective: Pregnancy risk assessment is to identify high-risk pregnant women through certain evaluation criteria screening,so as to strengthen the prenatal health management,to avoid the adverse outcomes of critical pregnant women and perinatal babies.Currently,there are a variety of risk assessment criterias for pregnancy,each of which contains different risk factors.Which assessment criteria is more conducive to screening high-risk pregnant women has not been reported so far.There are also many high risk factors that affect the critical outcome of pregnant women and the adverse outcome of newborns.However,there is no big data study on the relationship between each high risk factor and the critical/adverse outcome of pregnancy.In addition,pregnancy risk assessments are usually manually labeled,time-consuming and laborious,and data from different institutions and different pregnancies cannot be shared.Therefore,this study aims to use real world data,evaluate the relationship between different pregnancy risk assessment or all kinds of risk factors and pregnancy outcome.This study also sets up a big data platform of maternal management and a new intelligent pregnancy risk assessment to improve the efficiency of risk assessment and evaluation of the accuracy of pregnancy.Part I: The analysis of the correlation between different pregnancy risk assessment criteria and critical pregnancy outcome Objective:To analyze the correlation between the risk assessment level of high risk and the outcome of pregnancy with Hangzhou and the national pregnancy risk assessment standards.Methods: Choose 30383 cases of pregnant and parturient women who accept maternal care of in Hangzhou on January 1 to December 31,2017,in Hangzhou fivecritical monitoring maternal hospital.By using the big data method,the correlation between the risk assessment level of high risk and the outcome of pregnancy was analyzed respectively by using the Hangzhou pregnancy risk assessment standard and the national pregnancy risk assessment standard Results:1.High-risk pregnancy incidence in 2017(1)24 weeks ago: Hangzhou version of high-risk assessment results: there are10,770 cases of high-risk pregnant women,with a high-risk rate of 35.4%.The national version of high-risk assessment results: there were 16837 high-risk pregnant women,with a high-risk incidence of 55.4%.(2)Before delivery: Hangzhou version of high-risk assessment results: there were 15969 high-risk pregnant women,with a high-risk incidence of 52.6%.The national high risk assessment results,there were 21,449 high-risk pregnant women,with a high risk incidence of 70.6%.The incidence of high-risk in the national version was higher than that in the Hangzhou version,and the incidence of high-risk in the same standard before delivery was higher than that 24 weeks ago.2.Incidence of critical outcomes in 2017:There were 154 cases of women with WHO critical outcomes,512 cases of women with other critical outcomes,617 cases of women with all critical outcomes(including WHO and other critical outcomes),and 5442 cases of women with neonatal adverse outcomes.3.Two evaluation criterias and critical outcome analysis of Hangzhou edition and national edition(1)WHO critical outcome24 weeks ago: Assessment is no high-risk,and Hangzhou critical outcome incidence was 0.3%,the national version was 0.3%.Assessment for high risk,mild version of hangzhou 0.7% incidence of severe outcome,national edition was 0.6%,the assessment for high risk,moderate hangzhou version 1.1% incidence of severe outcome,national edition was 1.0%,the assessment for high risk,heavy hangzhou version 3.6% incidence of severe outcome,country version of 2.5%.Before delivery: Assessment is no high-risk,and Hangzhou critical outcome incidence was 0.4%,the national version was 0.3%.Aassessment for high risk,mild version of critical rate 0.4%,Hangzhou national edition was 0.5%,the assessment for high risk,moderate countries and Hangzhou editions of critically ill ending rates were1.0%,assessment of severe high-risk,Hangzhou version occurred severe outcome incidence of 7.3%;The national version is 1.4%.Specificity and sensitivity of assessment criteria:24 weeks ago: Sensitivity of Hangzhou edition 0.56(95%CI: 0.48-0.64),sensitivity of national edition 0.76(95%CI: 0.68-0.82);The specificity of the Hangzhou version was 0.65(95%CI: 0.64-0.65),and the specificity of the national version was 0.45(95%CI: 0.44-0.45).Before delivery: sensitivity of Hangzhou edition was 0.62(95%ci: 0.54-0.70),and sensitivity of national edition was 0.85(95%CI: 0.78-0.90).The specificity of the Hangzhou version was 0.47(95%CI: 0.47-0.48),and the specificity of the national version was 0.29(95%CI: 0.29-0.30).(2)For all critical maternal outcomes(including WHO and other critical maternal outcomes)24 weeks ago: Assessment is no high-risk,Hangzhou and the national critical outcome incidences were 1.6%.Assessment for high risk,mild version of Hangzhou occurred 2.6% incidence of severe outcome,national edition incidence was 2.3%,the assessment for high risk,moderate version of Hangzhou occurred 3.2% incidence of severe outcome,national edition incidence was 2.7%,the assessment for severe high-risk,Hangzhou version 7.3% incidence of severe outcome,national edition incidence was 5.0%.Before delivery:Assessment is no high-risk,and Hangzhou incidence of severe outcome was 1.6%,the national version was 1.5%.The assessment for high risk,mild version of critical rate 2.1%,Hangzhou national edition was 2.2%,the assessment for high risk,moderate 2.8% incidence of Hangzhou version occurred severe outcome,national edition was 2.7%,the assessment for severe high-risk,Hangzhou version occurred severe outcome incidence of 17.1%;The national rate was 6.8 percent.Sensitivity and specificity of assessment criteria:24 weeks ago: Sensitivity of Hangzhou edition 0.48(95%CI: 0.44-0.52),and sensitivity of national edition 0.65(95%CI: 0.62-0.69).The specificity of the Hangzhou version was 0.65(95%CI: 0.64-0.65),and the specificity of the national version was 0.45(95%CI: 0.44-0.45).Before delivery: Sensitivity of Hangzhou edition was 0.62(95%CI: 0.58-0.66),and sensitivity of national edition was 0.79(95%CI: 0.75-0.82).The specificity of the Hangzhou version was 0.48(95%CI: 0.47-0.48),and the specificity of the national version was 0.30(95%CI: 0.29-0.30).(3)Perinatal adverse outcome24 weeks ago:Assessment is a high-risk,Hangzhou incidence of poor perinatal outcomes version 14.8,the country version of 14.3%.The assessment for high risk,mild version of Hangzhou occurred 22.6% incidence of adverse outcomes,national version 19.5%,evaluation for moderately high-risk,Hangzhou version 26.3%incidence of adverse outcomes,national version 26.4%,assessment of severe high-risk,Hangzhou version 60% incidence of adverse outcomes,country version of29.2%.Before delivery:Assessment is a high-risk,and Hangzhou in the incidence of adverse outcomes of 14.8%,12.8% national version.Evaluation for mild high-risk,Hangzhou version of adverse incidence of 19.5%,18.8% national version,evaluation for moderately high-risk,Hangzhou version 23.6% incidence of adverse outcomes,national version 26.7%,assessment of severe high-risk,Hangzhou version aderse outcome occurred rate 63.4%;The national version is 32.4 percent.Sensitivity and specificity of assessment criteria:Week 24: Sensitivity of Hangzhou edition 0.47(95%CI: 0.45-0.48),sensitivity of national edition 0.64(95%CI: 0.63-0.66),specificity of Hangzhou edition 0.67(95%CI: 0.66-0.68)and specificity of national edition 0.47(95%CI: 0.46-0.47).Before delivery: the sensitivity of the Hangzhou edition was 0.61(95%CI: 0.60-0.62),the sensitivity of the national edition was 0.79(95%CI: 0.78-0.80),the specificity of the Hangzhou edition was 0.49(95%CI: 0.49-0.50),and the specificity of the national edition was 0.31(95%CI: 0.31-0.32).Conclusion: Compared with the national version,the Hangzhou version has higher specificity and lower sensitivity than the national version.The pre-delivery evaluation was more sensitive than the 24-week evaluation.Part II The correlation analysis between the risk factors and pregnancy outcome Objective:To analyze the correlation between risk factors and pregnancy outcomes.Methods : A total of 30,383 cases of pregnant women who were hospitalized for delivery,had pregnancy outcome and received maternity care in obstetrics department of 5 monitoring hospitals for pregnant women in Hangzhou on January 1,2017 and December 31,2017 were collected.Big data analysis was used to analyze the correlation between various high-risk factors and pregnancy outcome Results;Different risk factors were related to pregnancy outcome.(1)Risk factors leading to WHO critical outcome were: cesarean section for 1time,scar uterus for more than 18 months and less than 5 years,hypertensive diseases during pregnancy and thrombotic diseases(P<0.05).(2)In addition to the above four factors,there were also 6 factors(P<0.05)that led to WHO critical outcome and other maternal critical outcome(P<0.05).(3)Only lead to poor perinatal outcomes of risk factors have a BMI of 25 or more,perinatal death history,the history of history of macrosomia delivery,low birth weight,appendix surgery history,intrahepatic cholestasis(ICP),malposition,pregnancy with slow disease high blood pressure,expired pregnancy,second liver virus carried,thyroid function is low,uterine fibroids,etc.12(P < 0.05).(4)The risk factors of WHO critical outcome and perinatal adverse outcome were 2 cesarean sections or more than 2 times and 2 years of infertility(P<0.05).(5)In addition to the above two types of severe maternal outcomes and perinatal adverse outcomes,there were also four types of premature delivery history,threatened premature delivery,premature rupture of membranes,and birth weight≥4000g4(P<0.05).(6)At the same time,in addition to the above 6 risk factors,there were 8 risk factors including placenta pravia,twin,puerperal infection,anemia(hemochromatosis<70g/L),pregnancy complicated with heart disease,pregnancy complicated with kidney disease,number of abortions ≥3,and birth weight <2500g(P<0.05).(7)On maternal and poor perinatal outcomes in acute 15 kind of no effect,for mental retardation,illiteracy,short stature,vagina childbirth history,history of congenital malformations,history of severe preeclampsia,kidney disease history,history of postpartum hemorrhage,assisted reproductive higher pregnancy,psychosis,blood fat,early exposure to pesticides,first-degree relatives genetic history,hyperthyroidism,ovarian benign tumor.Part III The establishment and application of the new risk assessment model Objective:To establish a new risk assessment model based on the previous model Method:Ased on knowledge base and data driven hybrid intelligent health assessment technology,combined with the first and the second part of the results of the study,obstetric clinical guidelines,intelligent expert consensus,a new pregnancy risk assessment tool was researched.27839 cases who were accept maternal care in Hangzhou maternal real-time evaluation and delivered on January 1,2018 to December 31,2018 in Hangzhou five critical monitoring maternal hospital maternity department in the hospital were researched to compare the of the new pregnancy risk assessment standards,the merits of the original evaluation criteria and the national edition.Results:1.Incidence of high-risk pregnancies in 2018According to the new risk assessment results,13,988 pregnant women were at high risk,with a high risk incidence of 50.24%.According to the high risk assessment results of Hangzhou edition,10,602 pregnant and lying-in women at high risk were found,with a high risk incidence of 38.08%.According to the national high risk assessment,17860 pregnant and lying-in women were at high risk,with a high risk incidence of 65.2%.2.Incidence of critical outcomes in 2018There were 160 cases of women with WHO critical outcomes,522 cases of women with other critical outcomes,623 cases of women with all critical outcomes(including WHO and other critical outcomes),and 3613 cases of women with adverse neonatal outcomes.3.Analysis of various evaluation criteria and critical outcomes in 2018(1)WHO critical outcome:The new version was assessed as non-high risk,with the incidence of critical outcome being 0.3%,mild high risk,0.72%,moderate high risk,1.33%,severe high risk and 10.42%.The Hangzhou version was assessed as non-high risk,with the incidence of critical outcome 0.33%,mild high risk,0.83%,moderate high risk,1.25%,severe high risk and 12.24%.The incidence of critical outcome was 0.62% in the national version,0.35% in the case of mild high risk,0.56% in the case of moderate high risk,10.57% in the case of severe high risk.Sensitivity and specificity: the sensitivity of the new version was 0.74(95%CI:0.67-0.81),the sensitivity of the Hangzhou version was 0.64(95%CI: 0.56-0.72),the sensitivity of the national version was 0.61(95%CI: 0.53-0.69),the specificity of the new version was 0.50(95%CI: 0.49-0.50),and the specificity of the Hangzhou version was 0.62(95%CI: 0.61-0.63).National version specificity 0.36(95%CI:0.35-0.36).(2)For all maternal critical outcomesThe new version was assessed as non-high risk,with the incidence of critical outcome 1.83%,mild high risk,2.35%,moderate high risk,3.90%,severe high risk and 16.67%.The Hangzhou version was assessed as non-high risk,with the incidence of critical outcome being 1.87%.For those assessed as mild high risk,the incidence of critical outcome being 2.42%,moderate high risk,3.98%,severe high risk and22.45%.The national version was assessed as non-high risk,with the incidence of critical outcome being 2.34%,mild high risk being 1.76%,moderate high risk being2.50%,severe high risk being 16.74%.Sensitivity and specificity:The sensitivity of the new version was 0.59(95%CI: 0.55-0.63),the sensitivity of the Hangzhou version was 0.48(95%CI: 0.44-0.52),the sensitivity of the national version was 0.62(95%CI: 0.59-0.66),the specificity of the new version was 0.50(95%CI: 0.49-0.51),the specificity of the Hangzhou version was 0.62(95%CI:0.62-0.63),and the specificity of the national version was 0.36(95%CI: 0.35-0.36).(3)For perinatal adverse outcomes:Hangzhou Hangzhou Hangzhou Hangzhou Hangzhou Hangzhou Hangzhou Hangzho u The new version was assessed as non-high-risk,with the incidence of perinatal adverse outcome being 9%,mild high-risk,15.86%,moderate high-risk,22.04% and severe high-risk,with the incidence of adverse outcome being 43.75%.Hangzhou version of the evaluation is no high risk,the incidence of aderse outcome 9.88%.Assessment for high risk,mild in 17.03% incidence of adverse outcomes,assessment for high risk,moderate in 21.20% incidence of adverse outcomes,assessment for high risk,heavy occurred 46.94% incidence of adverse outcomes,national assessment for the high-risk version,in the incidence of adverse outcome was 16.16%,the assessment for the high risk of mild,occurred 9.35%incidence of adverse outcomes,assessment for high risk,moderate occurred 13.39%incidence of adverse outcomes,assessment for high risk,heavy 56.83% incidence of adverse outcomes.Sensitivity and specificity: the sensitivity of the new version was 0.66(95%CI:0.64-0.67),the sensitivity of the Hangzhou version was 0.53(95%CI: 0.51-0.55),and the sensitivity of the national version was 0.55(95%CI: 0.54-0.57).The specificity of the new version was 0.52(95%CI: 0.51-0.53),the specificity of the Hangzhou version was 0.64(95%CI: 0.64-0.65),and the specificity of the national version was0.35(95%CI: 0.34-0.35).(4)For all maternal critical/perinatal adverse outcomes:The new version was assessed as non-high risk,with a incidence of critical/adverse outcome of 10.12%,mild high risk,16.93%,moderate high risk,23.46%,severe high risk,and 47.92%.The Hangzhou version was assessed as non-high risk,with the incidence of critical/adverse outcome being 10.98%,mild high risk being 18.07%,moderate high risk being 22.63%,severe high risk being 55.10%.According to the national assessment,the incidence of critical/adverse outcomes was not high risk,17.30%,10.44%,16.46%,and 61.23%,respectivelySensitivity and specificity: the sensitivity of the new version was 0.64(95%CI:0.63-0.66),the sensitivity of the Hangzhou version was 0.52(95%CI: 0.50-0.53),and the sensitivity of the international version was 0.56(95%CI: 0.54-0.58).The specificity of the new version was 0.52(95%CI: 0.51-0.53),the specificity of the Hangzhou version was 0.64(95%CI: 0.64-0.65),and the specificity of the national version was 0.35(95%CI: 0.34-0.35).Conclusion: By comparing different risk assessment criteria,different risk factors and pregnancy outcome in real world studies,the sensitivity and specificity of the current Hangzhou standard and the national standard have their own advantages and disadvantages.Some current risk factors have no significant effect on pregnancy outcome.The accuracy and efficiency of the assessment can be improved by setting up the electronic medical record and the data center for women and children in the obstetrics clinic.The new sensitive edition was consistent with the national edition,higher than the Hangzhou edition,and the new specific edition was lower than the Hangzhou edition but higher than the national edition.Comprehensive evaluation shows that the sensitivity and specificity of the new version are better than those of the original two standards. |
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