ObjectiveTo construct a scoring model for predicting red blood cells transfusion risk of pregnant women during perinatal period and verify its efficacy.
MethodsFrom January 2016 to January 2019, a total of 4 593 pregnant women who underwent routine prenatal examination and delivery in Peking University Medical Luzhong Hospital were selected as the subjects. The age of pregnant women was (28.1±3.3) years, and the gravidity was (1.8±0.5) times. There were 3 164 cases of primiparas, and 1 429 cases of postpartums. According to whether these pregnant women received red blood cells transfusion during perinatal period, they were divided into transfusion group (n=96) and non-transfusion group (n=4 497). Retrospective study method was used to collect the general clinical and delivery related data of the pregnant women in two groups. In univariate analysis, the independent-samplesttest was used to compare measurement data of pregnant women between two groups, such as age, pre-pregnancy body mass index (BMI) and gravidity etc.. And chi-square test or Fisher′s exact probabilities was used to compare enumeration data, such as the proportion of pregnant women and the incidence of complications during pregnancy etc.. According to the results of univariate analysis, previous research results and clinical experience, the factors influencing red blood cells transfusion of pregnant women during perinatal period were included in the multivariate unconditional logistic regression analysis. R software was used to draw the risk nomogram of red blood cells transfusion of pregnant women during perinatal period, and the predictive risk-scoring model for red blood cells transfusion of pregnant women during perinatal period was established. The Bootstrap sampling method was used to repeat self-sampling 500 times, in order to internally verified the predictive risk-scoring model for red blood cells transfusion of pregnant women. According to the risk-predictive scoring model, draw the calibration curve for red blood cells infusion rates of pregnant women during perinatal period, in order to evaluate the consistency of the predicted and actual red blood cells transfusion rates. The procedures followed in this study were in line with the requirements of theWorld Medical Association Declaration of Helsinkirevised 2013.
Results① In this study, the results of univariate analysis of factors influencing the red blood cells transfusion of pregnant women during perinatal period in two groups showed that the age, pre-pregnancy BMI, proportion of multipara, prenatal severe anemia, cesarean section, placenta previa, placental abruption, preeclampsia, multifetal pregnancy, macrosomia of pregnant women in transfusion group, were all higher than those of non-transfusion group, and the differences were statistically significant (t=4.950,P<0 .001;t=2.291,P=0.022;χ2=4.14,P=0.042;P<0 .001;χ2=20.348,P<0 .001;P<0 .001;P<0 .001;P<0 .001;χ2=7.519,P=0.006;P=0.011). ② The results of multivariate unconditional logistic regression analysis showed that increasing maternal age (OR=1.183, 95%CI:1.113-1.258,P<0 .001), prenatal severe anemia (OR=12.167, 95%CI:1.269-116.608,P=0.030), cesarean section (OR=6.118, 95%CI:1.099-34.042,P=0.039), placenta previa (OR=9.204, 95%CI:1.207-70.198,P=0.032), placental abruption (OR=10.714, 95%CI:1.125-102.044,P=0.039), preeclampsia (OR=4.003, 95%CI:1.097-14.606,P=0.036) and macrosomia (OR=1.183, 95%CI:1.113-1.285,P<0 .001) were the independent risk factors influencing red blood cells transfusion of pregnant women during perinatal period. ③ according to the nomogram of the predictive risk-scoring model of red blood cells transfusion of pregnant women during perinatal period, the consistency index of predictive risk-scoring model for red blood cells transfusion of pregnant women during perinatal period was 0.881 (95%CI:0.805-0.932). The results of calibration curve showed that the average absolute deviation between the predicted and actual red blood cells transfusion rate of pregnant women during perinatal period was 0.011, which proved that the predicted and actual red blood cells transfusion rates were in good consistence.
ConclusionsPredictive risk-scoring model for red blood cells transfusion of pregnant women during perinatal period was constructed based on the independent risk factors influencing red blood cells transfusion of pregnant women during perinatal period could effectively predict the risk of red blood cells transfusion of pergnant women during perinatal. However, the value of this scoring model for predicting risk of red blood cells transfusion of pregnant women during perinatal period in different regions needs to be further clarified by multi-center and large-sample studies.
