Construction and verification of nomogram prediction model of risk for perineal laceration in primiparas
ZHANG Han1 DUAN Xia1 PANG Qiying2 MAO Yanli3 ZHONG Minhui1 YU Chan1 YAN Xiaoxue1#br#
1.Department of Nursing, the First Maternity and Infant Hospital, Tongji University, Shanghai 201204, China;
2.Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China;
3.Department of Anesthesiology, Tenth People’s Hospital of Tongji University, Shanghai 200072, China
Abstract：Objective To construct the nomogram prediction model of risk for perineal laceration in primiparas. Methods A total of 932 primiparas from the First Maternity and Infant Hospital, Tongji University from December 2020 to September 2021 were selected as research objects. A total of 746 primiparas were used as the modeling group to construct the model, and they were divided into laceration group (506 cases) and non-laceration group (240 cases) according to whether perineal laceration occurred; 186 primiparas were included in validation group to validate the model. Logistic regression model was used to construct the model, Hosmer-Lemeshow goodness of fit, calibration curve, and receiver operating characteristic curve were used to evaluate the model. Results The first labor time, second labor time, and total labor time in laceration group were longer than those in non-laceration group, and the differences were statistically significant (P < 0.05). The proportion of full-term birth, suspected macrosomia, epidural analgesia, midwife outpatient service, fetal distress, and hypertension of pregnancy in laceration group was higher than that in non-laceration group, and the difference was statistically significant (P < 0.05); there were significant differences in perineal elasticity, length of perineal body, degree of puerperal cooperation, seniority of midwife, mode of induced labor, free position, delivery position, degree of fear of childbirth, and physical activity level during pregnancy between two groups (P < 0.05). Gestational age， suspected macrosomia, second labor time, degree of fear of childbirth, seniority of midwives, and physical activity level during pregnancy were the influencing factors of perineal lacerations in primiparas (P < 0.05). The Hosmer-Lemeshow goodness of fit and calibration curve indicated that the model fit was good. The area under the curve of the modeling group and the verification group were 0.822 and 0.799, respectively， and the prediction performance of the model was good. Conclusion The prediction model of risk for perineal laceration in this study has good differentiation and calibration, which can provide an efficient and convenient evaluation tool for clinical practice.
张涵1 段霞1 庞启英2 毛艳丽3 钟敏慧1 于婵1 严小雪1. 初产妇会阴裂伤风险列线图预测模型的建立与验证[J]. 中国医药导报, 2022, 19(27): 25-29.
ZHANG Han1 DUAN Xia1 PANG Qiying2 MAO Yanli3 ZHONG Minhui1 YU Chan1 YAN Xiaoxue1. Construction and verification of nomogram prediction model of risk for perineal laceration in primiparas. 中国医药导报, 2022, 19(27): 25-29.
[1] Royal College of Obstetrics and Gynaecology. Management of third and fourth degree perineal tears [EB/OL]. Greentop guideline NO29 2015. https：//www.rcog.org.uk/globalassets/documents/guidelines/gtg-29.pdf.
[2] 王晋芳.顺产产妇会阴损伤预防与修复循证实践方案的构建[D].北京：北京中医药大学，2018.
[3] American College of Obstetricians and Gynecologists’Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 165： Prevention and Management of Obstetric Lacerations at Vaginal Delivery [J]. Obstet Gynecol，2016，128（1）：e1-e15.
[4] Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 198： Prevention and Management of Obstetric Lacerations at Vaginal Delivery [J]. Obstet Gynecol，2018，132（3）：e87-e102.
[5] Thubert T，Cardaillac C，Fritel X，et al. Definition，epidemiology and risk factors of obstetric anal sphincter injuries： CNGOF Perineal Prevention and Protection in Obstetrics Guidelines [J]. Gynecol Obstet Fertil Senol，2018，46（12）：913-921.
[6] Harvey MA，Pierce M，Alter JE，et al. Obstetrical Anal Sphincter Injuries（OASIS）：Prevention，Recognition，and Repair [J]. J Obstet Gynaecol Can，2015，37（12）：1131-1148.
[7] 余景芳，王芬.湖北省黄石市妇幼保健院女性阴道分娩后肛门括约肌损伤的发生率及风险因素分析[J].中国妇产科临床杂志，2019，20（5）：439-440.
[8] 王英萍.产妇自然分娩时软产道裂伤的相关因素分析[J].中国医药指南，2019，17（34）：50-51.
[9] 王玲，王晓薇，王战云.无保护会阴分娩产妇会阴裂伤的危险因素分析[J].中国护理管理，2017，17（12）：1616-1619.
[10] 张涵，段霞.经阴道分娩产妇会阴损伤风险预测因子的研究进展[J].中国医药导报，2021，18（28）：59-62.
[11] 张涵，段霞.产科肛门括约肌损伤风险预测模型研究进展[J].护理学杂志，2021，36（18）：106-110.
[12] 屈宁宁，李可基.国际体力活动问卷中文版的信度和效度研究[J].中华流行病学杂志，2004，25（3）：87-90.
[13] 危娟，刘洁英，张莉芳，等.分娩恐惧量表的汉化及信效度检测[J].护理学杂志，2016，31（2）：81-83.
[14] 郭琳，丁焱，张铮，等.分娩时会阴切开决策影响因素预测模型的构建[J].中华护理杂志，2019，54（10）：1469-1474.
[15] Webb SS，Hemming K，Khalfaoui MY，et al. An obstetric sphincter injury risk identification system（OSIRIS）：is this a clinically useful tool? [J]. Int Urogynecol J，2017， 28（3）：367-374.
[16] Sydsj?觟 G，Angerbj?觟rn L，Palmquist S，et al. Secondary fear of childbirth prolongs the time to subsequent delivery [J]. Acta Obstet Gynecol Scand，2013，92（2）：210-214.
[17] 施展宏，吴蓓，胡显玲.孕妇保健操对初产妇分娩结局的影响[J].中华健康管理学杂志，2018，12（4）：339-343.
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