Abstract
Objective: The aim of this study was to develop a nomogram to predict the risk of premature rupture of membrane (PROM) in pregnant women with vulvovaginal candidiasis (VVC).Patients and methods: We developed a prediction model based on a training dataset of 417 gravidas with VVC, the data were collected from January 2013 to December 2020. The least absolute shrinkage and selection operator regression model was used to optimize feature selection for the model. Multivariable logistic regression analysis was applied to build a prediction model incorporating the feature selected in the least absolute shrinkage and selection operator regression model. Discrimination, calibration, and clinical usefulness of the prediction model were assessed using the C-index, calibration plot, and decision curve analysis. Internal validation was assessed using bootstrapping validation.Results: Predictors contained in the prediction nomogram included age, regular perinatal visits, history of VVC before pregnancy, symptoms with VVC, cured of VVC during pregnancy, and bacterial vaginitis. The model displayed discrimination with a C-index of 0.684 (95% confidence interval: 0.631–0.737). Decision curve analysis showed that the PROM nomogram was clinically useful when intervention was decided at a PROM possibility threshold of 13%.Conclusion: This novel PROM nomogram incorporating age, regular perinatal visits, history of VVC before pregnancy, symptoms with VVC, cured of VVC during pregnancy, and bacterial vaginitis could be conveniently used to facilitate PROM risk prediction in gravidas.
Highlights
Premature rupture of membrane (PROM) is defined as a spontaneous rupture of embryonic membrane occurring before the onset of labor
All the patients were divided into PROM and no PROM groups
Medical history, and treatment features, 23 features were reduced to 6 potential predictors on the basis of 417 patients in the cohort (Figure 1) and were associated with non-zero coefficients in the least absolute shrinkage and selection operator (LASSO) regression model
Summary
Premature rupture of membrane (PROM) is defined as a spontaneous rupture of embryonic membrane occurring before the onset of labor. PROM occurs in ∼8% of all deliveries [1] and can lead to adverse fetal and neonatal outcomes. Adverse outcomes include: for mothers, intra-amniotic infection, postpartum infection, endometritis; and for newborns, cord prolapse, respiratory distress syndrome, sepsis, intraventricular hemorrhage, and even death. Vulvovaginal candidiasis (VVC) is a common vaginitis that affects 75% of women at least once in their lifetime [2, 3]. More than one fifth of women have experienced recurrent VVC (at least 3 symptomatic episodes in a previous year) [4]. In high-income countries, recurrent VVC affects about 138 million women annually, and the economic burden from lost productivity is estimated to be up to billion annually [5]. Pregnancy increases the incidence of VVC owing to changes of the internal immune environment of the genital tract
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