Analysis of Risk Factors and Prediction Model Construction for Poor Healing of Perineal Wounds after Vaginal Delivery: A Retrospective Case-Control Study

Abstract

Background

Perineal wounds after vaginal delivery are very common, but the existing evidence for poor healing of perineal wounds is limited. Although some studies have analyzed the risk factors for poor perineal wound healing, there are currently no simple and practical predictive tools available for clinical use.

Objective

To retrospectively analyze the independent risk factors for poor perineal wound healing after vaginal delivery and to establish a risk prediction model for poor perineal wound healing.

Design

A Retrospective Case-Control Study.

Data Source

A total of 167 cases of poor perineal wound healing after vaginal delivery who visited the emergency department from May 2021 to September 2023 in our hospital were selected as the poor perineal wound healing group. The control group was randomly selected by the random number table method at a ratio of 1:2 from those with normal perineal wound healing during the same period.

Methods

Clinical indicators of the two groups were analyzed, and the risk factors for poor perineal wound healing were analyzed using univariate and multivariate Logistic regression analysis, and a risk prediction model was constructed. A nomogram was drawn, and the model was evaluated by discrimination and calibration.

Results

This study ultimately included four independent risk factors to construct the risk prediction model, including primiparity, perineal laceration, perineal laceration combined with laceration, and vaginal hematoma. The model formula was Z = 2.256 + 2.7 × (episiotomy with laceration) + 1.5 × (episiotomy) + 1.321 × (vaginal hematoma) + 0.904 × (primiparity). The area under the ROC curve of the constructed model was 0.757 (95% CI: 0.712-0.803), and the optimal cutoff value was 0.194, at which the model sensitivity was 0.952 and specificity was 0.759.

Conclusions

The risk prediction model for poor perineal wound healing after vaginal delivery can reasonably predict the risk of poor incision healing, providing a basis for obstetric medical staff to take preventive management measures for high-risk groups before the discharge of parturient women, thereby reducing the occurrence of poor perineal wound healing.