| Objectives:Compare the pregnancy outcomes of pregnant patients with different degrees of PAH to explore the risk factors leading to adverse pregnancy outcomes and establishment of a nomogram prediction model.Methods:This study was a retrospective case-control study that collected from 2017 to 2020 in Fujian medical university union hospital treated 76 cases of pregnancy with PAH patients,according to the pulmonary artery pressure,divided into mild(group A),moderate(group B),severe pulmonary hypertension group(group C),analysis of clinical data difference between three groups.The occurrence of maternal death,iatrogenic abortion,premature delivery,neonatal asphyxia and death were classified as the adverse pregnancy outcome group.Univariate analysis was conducted on the factors that may lead to adverse pregnancy outcomes,and P < 0.05 was taken to indicate that the factors that have a greater impact on adverse pregnancy outcomes.Those factors were included in multi-factor logistics regression analysis to obtain their independent risk factors(P< 0.05).Independent risk factors were used to establish clinical risk prediction nomograms through the R language(version 4.0.2)"RMS" package.The total score can be obtained by adding the scores corresponding to each risk factor in the histogram,and the risk probability of adverse pregnancy outcome can be obtained accordingly.According the ROC curves,the AUC was used to evaluate the independent risk factors and nomogram prediction model prediction ability,the AUC > 0.7 indicated the model had good prediction accuracy.The Bootstrap method was used for internal verification.The self-sampling was repeated for 1000 times,and the C-index was calculated to evaluate the accuracy of the model.Finally,Hosmer-Lemeshow was used to test the goodness of fit to judge the calibration ability of the model.P > 0.05 indicated that the difference between the predicted value and the observed value was not statistically significant,indicating that no departure from the perfect fit.Results:There were 51 cases in group A,14 cases in group B,and 11 cases in group C.The main causes of pregnant patients with PAH were congenital heart disease(42.11%),and most of them were found during pregnancy(97.37%).A and B group is given priority to with cardiac Ⅰ ～ Ⅱ level(94.12%,78.57%),group C is given priority to with cardiac Ⅲ ～ Ⅳ level(72.73%).NT-pro BNP,group C > group B>group A.A total of 47 cases(92.16%)labor in group A,12 cases(80.00%)in group B and 3 cases(23.08%)in group C.The gestational age,group A > group B>group C.Group A and B were mainly delivered at full term(76.60%and 58.33%,respectively),and group C were all premature.Cesarean section was the most common method for terminating pregnancy in group A and B(52.94%and 85.71%,respectively).Iatric abortion was the most common method in group C(72.73%).Among the groups with different pulmonary arterial pressure,gestational week,dyspnea,shortness of breath,cardiac function grading,the electric axis right,and pulmonary artery pressure,hemoglobin,D-dimer,the NT-pro BNP,delivery gestational age,whether the term,termination of pregnancy,anesthesia,transferred to the ICU and prognosis,neonatal weight difference was statistically significant.There were 33 cases of adverse pregnancy outcomes,including 15 cases in group A(29.41%),7 cases in group B(50.00%)and 11 cases in group C(100%).Multi-factor analysis finally be independent risk factors for pulmonary arterial pressure、the NT-pro BNP 、shortness of breath、anesthesia.The results showed that the AUC of pulmonary artery pressure,NT-pro BNP,shortness of breath and anesthesia mode were 0.748、0.823、 0.721 and 0.734.The AUC of the histogram was 0.899,which was higher than that of any other factor.After internal verification was taken,the C-index value is 0.892,indicating high accuracy of the model.Finally,Hosmer-Lemeshow was used to test the goodness of fit,and P=0.7332,indicating that the difference between the predicted value and the observed value was not statistically significant,indicating that no departure from the perfect fit.Conclusions:The higher the pulmonary pressure,the worse the cardiac function,the higher the level of NT-pro BNP,the lower the rate of delivery,the earlier gestational week of delivery,the higher the rate of cesarean section and adverse pregnancy outcomes.And surgical treatment during pregnancy can appropriately extend the gestational week in those PAH patients due to congenital heart disease.Pulmonary arterial pressure,NT-pro BNP,shortness of breath and anesthesia were independent risk factors for adverse pregnancy outcome.The nomogram prediction model is helpful to predict the probability of adverse pregnancy outcomes in pregnant patients with PAH. |
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