Analysis Of Factors Influencing Delayed Onset Of Lactogenesis And Construction Of A Predictive Model In Advanced Cesarean Section Mothers

Objective: To investigate the current situation of delayed onset of lactogenesis(DOL)in advanced caesarean section mothers,analyze the influencing factors of delayed onset of lactogenesis(DOL)in advanced caesarean section mothers,construct a risk prediction model accordingly,and provide a scientific theoretical basis for early prevention and care of DOL in advanced caesarean section mothers.Methods: A convenience sampling method was used to select the elderly women who underwent elective cesarean section from March 2021 to October 2021 at the Department of Obstetrics and Gynecology,Rui Kang Hospital,Guangxi University of Traditional Chinese Medicine and the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine as the study population.For 277 study subjects who met the inclusion and exclusion criteria,questionnaires were administered using the General Information Questionnaire,Fear Visual Analog Scale(FVAS),State Anxiety Inventory(S-AI),and Pittsburgh Sleep Quality Index(PSQI).Descriptive statistics,analysis of variance,model construction and internal validation analysis were performed for each index using SPSS 23.0 software.Results: 1.In this study,283 questionnaires were returned,277 of which were valid,with an effective rate of 98%,of which 106 cases had delayed lactation initiation(38.3%).2.The non-DOL and DOL groups were different in terms of number of pregnancies and deliveries,breastfeeding history,total fear and anxiety scores,total sleep score,number of primary caregivers,nipple pain during breastfeeding,primary feeding method,number of feedings on postoperative day 1,number of feedings on postoperative day 2,number of feedings on postoperative day 3,increase in BMI during pregnancy,indication for cesarean delivery,total number of comorbidities/complications in this pregnancy,time to first breastfeeding or expressing,postoperative The differences were statistically significant(P<0.05)in terms of the number of massage/lactation sessions.3.breastfeeding history [OR=0.302,95%CI(0.164,0.556)],total anxiety score [OR=1.071,95%CI(1.029,1.115)],number of primary caregivers[OR=0.204,95%CI(0.090,0.466)],number of feedings on postoperative day 2[OR=0.361,95% CI(0.184,0.705)],increase in BMI during pregnancy[OR=1.474,5%CI(1.109,1.959)],number of postoperative massage/lactation[OR=0.443,95%CI(0.244,0.803)],and primary feeding method(mixed feeding,predominantly manual feeding/exclusive breastfeeding)[OR=3.516,95% CI(1.481,8.344)] were predictors on the occurrence of DOL in women with advanced cesarean delivery.4.A logistic regression prediction model was constructed based on seven predictive variables: breastfeeding history,preoperative anxiety,number of primary caregivers,number of feedings on the second postoperative day,increase in BMI during pregnancy,primary feeding method,and number of postoperative breast massage/lactation,and the model was evaluated and internally validated.The results showed that the Omnibus test P<0.001 and the Hosmer-Lemeshow(H-L)test P=0.565>0.05,the overall accuracy of predicting morbidity was 77.3%,suggesting that the model was generally meaningful and well evaluated.the H-L test results also reflected that the prediction model had good calibration ability.the area under the ROC curve was The area under the ROC curve was 0.845,95% CI:0.797-0.892,the Jorden index = 0.580,the sensitivity = 0.802,and the specificity = 0.778,suggesting that the prediction model has good discriminatory ability.Conclusions: 1.The incidence of DOL is higher in women with advanced cesarean delivery.2.A multifactorial logistic regression analysis of DOL in women with advanced cesarean delivery found that increase in BMI during pregnancy,preoperative anxiety,and primary feeding method were risk factors,and breastfeeding history,number of primary caregivers,number of breastfeeding sessions on day 2 of surgery,and number of postoperative breast massages/lactation were protective factors.3.A risk prediction model for DOL in advanced cesarean delivery was established and validated internally with good predictive effect.It can provide a scientific basis for obstetrical medical staff to identify the risk of DOL in advanced cesarean section mothers as early as possible,prevent the occurrence of DOL,and improve the breastfeeding rate of mothers and the survival quality of newborns.