Risk Analysis And Prediction Model Development For Pregnant Women In Maternity

Objective1.To assess the risk factors of pregnant women and adverse pregnancy outcomes through expert consultation.2.To assess the established risk factors and adverse pregnancy outcomes of pregnant women,we can construct a risk predictive model for women in the delivery period,so as to provide a basis for predicting the adverse pregnancy outcomes.MethodsThe first part was the study of risk assessment factors for pregnant women:Firstly,We searched domestic and abroad databases such as CNKI(China National Knowledge Infrastructure),collect the document published literature on pregency risk assessment and influencing factors,to construct a draft of risk assessment for pregnant women.Secondly,expert discussions were held around on the draft risk assessment of pregnant women and major adverse pregnancy outcomes.Finally,after the revision of the expert consultation,the risk factors and adverse pregnancy outcomes for the delivery period were identified.The second part was the construction and evaluation of the risk assessment model for pregnant women: Based on the risk assessment factors of pregnant women determined in the previous research,it tested 852 pregnant women’s medical records January to June 2018 who lived in the third-grade hospitals in Henan Province by using a convenient sampling method.According the evaluation order and 30%: 70% principles,pregnant women were divided into model group(589 cases)and verification group(263 cases).Single factor and logistic multivariate analysis were completed by using model group samples.Then a risk prediction model were constructed for pregnant women during pregnancy trimester by regression analysis results.The fitting degree of the model was tested by Hosmer-Lemeshow.The model’s discriminating ability was tested by the receiver operating characteristic curve.ResultsThe first part: After literature review,13 clinical expert group discussions and12 expert consultations,formed an assessment content with 38 risk factors and 6dimensions including basic conditions,vital signs,pregnancy status,abnormal pregnancy,pregnancy complication,social psychology.The adverse pregnancy outcomes included 7 items including premature delivery,emergency birth/cesarean section,neonatal poor breathing/asphyxia,postpartum hemorrhage,stillbirth,neonatal transfer to NICU,and birth diagnosis as high risk.The second part: Among the 852 pregnant women,there were 375 adverse pregnancy events.Among them,premature delivery and neonatal poor breathing/asphyxia were the most common,with the incidences being as high as26.88% and 5.63% respectively.After single factor and multi-factor analysis,it was found that gestational weeks,high weight gain during pregnancy,amniotic fluid index,antenatal hemorrhage,etal 12 factors were independent element affecting the adverse pregnancy outcome of pregnant women(P <0.05).Construct a risk assessment model for pregnant women,LogitP=-2.143+1.418 ×gestational weeks+0.588×high weight gain in during pregnancy+1.376×systolicblood pressure Ⅰ +1.911 × systolic blood pressure Ⅱ +0.987 × amniotic fluidindex+1.768 × antenatal hemorrhage+1.667 × fetal heart rate andmovement+1.718 × multiple pregnancy+0.639 × cord around neck onecircle+2.307 × cord around neck more two circles and above+0.908 × threatenedpreterm labor+1.706 × assissted reproductive conception+1.393 × endocrinedisesse+1.822×anemia in pregnancyThe area under the ROC curve was 0.870 、 0.828,respectively.When the cumulative score a reached-1.9,Youden’s index became the largest of 0.604,thesensitivity and specificity was 77.5%%,82.9%,respectively.Hosmer-Lemeshow goodness-of-fit test(=6.003,P>0.001).Test model accuracy based on criticalpoint,the sensitivity and specificity was78.06%,68.51%,respectively(P<0.001).ConclusionsThe present study screened the risk factors for adverse pregnancy outcome through expert consultation and other mathods.The factors included gestational weeks,high weight gain in pregnancy,systolic blood pressure,amniotic fluid index,antenatal hemorrhage,fetal heart rate and movement,multiple births,cord around neck,threatened preterm labor,assissted reproductive conception,endocrine disease and anemia in pregnancy.The incidence of adverse pregnancy outcome could be established by the number of risk factors,so that the pregnant women at high risk factor scould be screened to sure the safety of pregnant women and nowborn.