Analysis of influencing factors of medical abortion failure of pregnant women in early pregnancy and construction of related prediction model and its predictive value for medical abortion success

doi:10.3877/cma.j.issn.1673-5250.2023.05.013

Objective

To explore the influencing factors of medical abortion failure of pregnant women in early pregnancy and constructing a related prediction model, and to evaluate its predictive value for medical abortion success of pregnant women in early pregnancy.

Methods

A total of 323 women with medical abortion in early pregnancy who were treated in the outpatient clinic department of Yancheng TCM Hospital from January 2020 to December 2022, were included in the study. Took a retrospective analysis method, based on outcomes of medical abortion, they were divided into failure group (n=35) and success group (n=288). Univariate analysis and multivariate unconditional logistic regression analysis were utilized to analyze the influencing factors of medical abortion failure of pregnant women in early pregnancy, and to construct a related predictive model for the success of medical abortion of pregnant women in early pregnancy. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the predictive value of this model for the success of medical abortion of pregnant women in early pregnancy. This study was in line with World Medical Association Declaration of Helsinki revised in 2013. Participants were granted their informed consent for diagnosis and treatments, substantiated by signing informed consent forms.

Results

①The results of univariate analysis showed that the number of pregnancies and childbirth (≤1 time, >1 time) of subjects, history of previous abortions, uterine position (horizontal, non-horizontal), gestational sac diameter (average of the three diameters of the gestational sac)(<20 mm, ≥20 mm), and history of chronic pelvic inflammatory disease could be potential influencing factors of the failure of medical abortion of pregnant women in early pregnancy. ②The results of multivariate unconditional logistic regression analysis showed that history of previous abortions (OR=7.791, 95%CI: 3.234-18.767, P<0.001), non-horizontal uterine position (OR=4.614, 95%CI: 1.990-10.702, P<0.001), and gestational sac diameter ≥20 mm (OR=6.564, 95%CI: 2.709-15.905, P<0.001) were all independent risk factors for the failure of medical abortion of pregnant women in early pregnancy. ③ The area under curve (AUC) of ROC, sensitivity and specificity of the prediction model for the success of medical abortion of pregnant women in early pregnancy based on the above three independent risk factors were 0.846, 95.7% and 90.6% respectively, which were higher than those of predicted by any one of the three factors, and this prediction model has a good fitting degree (Hosmer-Leme showed χ²=2.02, P=0.732).

Conclusion

The prediction model constructed based on three independent risk factors for the failure of medical abortion of pregnant women in early pregnancy including the history of previous abortions, uterine position and gestational sac diameter, holds certain predictive value for the success of medical abortion of pregnant women in early pregnancy.

Key words: Pregnancy trimester, first, Abortion, induced, Root cause analysis, Risk factors, Logistic models, ROC curve, Pregnant women

表1 早孕期孕妇药物流产失败的单因素分析结果

组别	例数	年龄(岁，±s)	孕龄(d，±s)	孕产次[例数(%)]		婚姻状况[例数(%)]
组别	例数	年龄(岁，±s)	孕龄(d，±s)	≤1次	>1次	未婚	已婚
成功组	288	28.4±5.0	52.4±4.0	247(85.8)	41(14.2)	49(17.0)	239(83.0)
失败组	35	28.6±4.8	52.7±3.8	23(65.7)	12(34.3)	7(20.0)	28(80.0)
统计量		t＝0.24	t＝0.30	χ²＝9.15		χ²＝0.19
P值		0.810	0.766	0.002		0.659
组别	例数	文化程度[例数(%)]			月收入[例数(%)]		既往流产史[例数(%)]
组别	例数	初中及以下	高中及中专	大专及以上	≤2 000元	>2 000元	既往流产史[例数(%)]
成功组	288	31(10.8)	84(29.2)	173(60.0)	57(19.8)	231(80.2)	61(21.2)
失败组	35	4(11.4)	10(28.6)	21(60.0)	8(22.9)	27(77.1)	21(60.0)
统计量		χ²＝0.02			χ²＝0.18		χ²＝24.83
P值		0.992			0.669		<0.001
组别	例数	职业[例数(%)]					宫颈物理治疗史[例数(%)]
组别	例数	公司职员	工人	学生	公务员	无业/待业	宫颈物理治疗史[例数(%)]
成功组	288	107(37.2)	89(30.9)	47(16.3)	23(8.0)	22(7.6)	48(16.7)
失败组	35	12(34.3)	10(28.6)	6(17.1)	4(11.4)	3(8.6)	6(17.1)
统计量		χ²＝0.62					χ²＝0.01
P值		0.961					0.943
组别	例数	停经时间[例数(%)]		避孕方式[例数(%)]		子宫位置[例数(%)]
组别	例数	<49 d	49～63 d	口服避孕药	避孕套	水平位	非水平位
成功组	288	157(54.5)	131(45.5)	52(18.1)	236(81.9)	221(76.7)	67(23.3)
失败组	35	19(54.3)	16(45.7)	7(20.0)	28(80.0)	16(45.7)	19(54.3)
统计量		χ²＝0.01		χ²＝0.08		χ²＝15.37
P值		0.980		0.779		<0.001
组别	例数	孕囊直径[例数(%)]		阴道炎[例数(%)]	慢性盆腔炎[例数(%)]	子宫肌瘤[例数(%)]
组别	例数	<20 mm	≥20 mm	阴道炎[例数(%)]	慢性盆腔炎[例数(%)]	子宫肌瘤[例数(%)]
成功组	288	207(71.9)	81(28.1)	37(12.9)	46(16.0)	52(18.1)
失败组	35	13(37.1)	22(62.9)	5(14.3)	13(37.1)	7(20.0)
统计量		χ²＝17.33		χ²＝0.06	χ²＝9.37	χ²＝0.08
P值		<0.001		0.811	0.002	0.779

表1 早孕期孕妇药物流产失败的单因素分析结果

组别	例数	年龄(岁，±s)	孕龄(d，±s)	孕产次[例数(%)]		婚姻状况[例数(%)]
组别	例数	年龄(岁，±s)	孕龄(d，±s)	≤1次	>1次	未婚	已婚
成功组	288	28.4±5.0	52.4±4.0	247(85.8)	41(14.2)	49(17.0)	239(83.0)
失败组	35	28.6±4.8	52.7±3.8	23(65.7)	12(34.3)	7(20.0)	28(80.0)
统计量		t＝0.24	t＝0.30	χ²＝9.15		χ²＝0.19
P值		0.810	0.766	0.002		0.659
组别	例数	文化程度[例数(%)]			月收入[例数(%)]		既往流产史[例数(%)]
组别	例数	初中及以下	高中及中专	大专及以上	≤2 000元	>2 000元	既往流产史[例数(%)]
成功组	288	31(10.8)	84(29.2)	173(60.0)	57(19.8)	231(80.2)	61(21.2)
失败组	35	4(11.4)	10(28.6)	21(60.0)	8(22.9)	27(77.1)	21(60.0)
统计量		χ²＝0.02			χ²＝0.18		χ²＝24.83
P值		0.992			0.669		<0.001
组别	例数	职业[例数(%)]					宫颈物理治疗史[例数(%)]
组别	例数	公司职员	工人	学生	公务员	无业/待业	宫颈物理治疗史[例数(%)]
成功组	288	107(37.2)	89(30.9)	47(16.3)	23(8.0)	22(7.6)	48(16.7)
失败组	35	12(34.3)	10(28.6)	6(17.1)	4(11.4)	3(8.6)	6(17.1)
统计量		χ²＝0.62					χ²＝0.01
P值		0.961					0.943
组别	例数	停经时间[例数(%)]		避孕方式[例数(%)]		子宫位置[例数(%)]
组别	例数	<49 d	49～63 d	口服避孕药	避孕套	水平位	非水平位
成功组	288	157(54.5)	131(45.5)	52(18.1)	236(81.9)	221(76.7)	67(23.3)
失败组	35	19(54.3)	16(45.7)	7(20.0)	28(80.0)	16(45.7)	19(54.3)
统计量		χ²＝0.01		χ²＝0.08		χ²＝15.37
P值		0.980		0.779		<0.001
组别	例数	孕囊直径[例数(%)]		阴道炎[例数(%)]	慢性盆腔炎[例数(%)]	子宫肌瘤[例数(%)]
组别	例数	<20 mm	≥20 mm	阴道炎[例数(%)]	慢性盆腔炎[例数(%)]	子宫肌瘤[例数(%)]
成功组	288	207(71.9)	81(28.1)	37(12.9)	46(16.0)	52(18.1)
失败组	35	13(37.1)	22(62.9)	5(14.3)	13(37.1)	7(20.0)
统计量		χ²＝17.33		χ²＝0.06	χ²＝9.37	χ²＝0.08
P值		<0.001		0.811	0.002	0.779

图1 早孕期孕妇药物流产失败的多因素非条件logistic回归分析森林图

表2 早孕期孕妇药物流产失败的多因素非条件logistic回归分析

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
孕产次>1次(vs ≤1次)	0.756	0.482	2.462	0.117	2.129	0.828～5.473
既往流产史(vs无既往流产史)	2.053	0.449	20.947	<0.001	7.791	3.234～18.767
子宫位置非水平位(vs水平位)	1.529	0.429	12.693	<0.001	4.614	1.990～10.702
孕囊直径≥20 mm(vs <20 mm)	1.882	0.452	17.360	<0.001	6.564	2.709～15.905
慢性盆腔炎(vs无慢性盆腔炎)	0.631	0.459	1.887	0.170	1.879	0.764～4.622
常数项	－4.651	0.513	82.097	<0.001	0.010	－

表2 早孕期孕妇药物流产失败的多因素非条件logistic回归分析

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
孕产次>1次(vs ≤1次)	0.756	0.482	2.462	0.117	2.129	0.828～5.473
既往流产史(vs无既往流产史)	2.053	0.449	20.947	<0.001	7.791	3.234～18.767
子宫位置非水平位(vs水平位)	1.529	0.429	12.693	<0.001	4.614	1.990～10.702
孕囊直径≥20 mm(vs <20 mm)	1.882	0.452	17.360	<0.001	6.564	2.709～15.905
慢性盆腔炎(vs无慢性盆腔炎)	0.631	0.459	1.887	0.170	1.879	0.764～4.622
常数项	－4.651	0.513	82.097	<0.001	0.010	－

图2 本研究基于3项独立危险因素构建的相关预测模型，对预测早孕期孕妇药物流产成功的ROC曲线注：基于既往流产史、子宫位置、孕囊直径3项独立危险因素构建相关预测模型。ROC曲线为受试者工作特征曲线

表3 本研究构建预测模型的不同预测因素对早孕期孕妇药物流产成功的预测价值分析

预测因素	AUC	AUC 95%CI	P值	最佳临界值	敏感度(%)	特异度(%)	约登指数
既往流产史	0.694	0.595～0.794	<0.001	0.500	60.0	78.8	0.388
子宫位置	0.655	0.553～0.757	0.003	0.500	54.3	76.7	0.310
孕囊直径(mm)	0.674	0.576～0.771	0.001	0.500	62.9	71.9	0.348
PRE_1	0.846	0.777～0.915	<0.001	0.195	95.7	90.6	0.863

表3 本研究构建预测模型的不同预测因素对早孕期孕妇药物流产成功的预测价值分析

预测因素	AUC	AUC 95%CI	P值	最佳临界值	敏感度(%)	特异度(%)	约登指数
既往流产史	0.694	0.595～0.794	<0.001	0.500	60.0	78.8	0.388
子宫位置	0.655	0.553～0.757	0.003	0.500	54.3	76.7	0.310
孕囊直径(mm)	0.674	0.576～0.771	0.001	0.500	62.9	71.9	0.348
PRE_1	0.846	0.777～0.915	<0.001	0.195	95.7	90.6	0.863

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