ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1649657
This article is part of the Research TopicBeyond Childbirth: Cardiovascular Consequences of Hypertensive Disorders in PregnancyView all articles
Development and Validation of a Prediction Model for Hypotension after Neuraxial Anesthesia in Preeclamptic Parturients: A Multicenter Retrospective Study
Provisionally accepted
- 1Fuzhou University, Fuzhou, China
- 2The First Affiliated Hospital of Xiamen University, Xiamen, China
- 3Zhangzhou Municipal Hospital of Fujian Province, Zhangzhou, China
- 4Fujian Provincial Hospital, Fuzhou, China
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Objective: To develop and validate a multivariate prediction model for hypotension following neuraxial anesthesia in preeclamptic parturients. Methods: This multicenter retrospective study analyzed 1,402 preeclamptic parturients (gestational age ≥28 weeks) from three tertiary centers (2013– 2024). After exclusions (n=569), 833 patients were allocated to training (n=495), internal validation (n=213), and external validation (n=125) cohorts. Multivariable logistic regression identified independent predictors, with subsequent nomogram construction. Model performance was assessed via discrimination (AUC), calibration (Hosmer-Lemeshow), and clinical utility (decision curve analysis [DCA], clinical impact curves [CIC]). Results: Seven independent predictors were identified: platelet count (OR 0.920, 95%CI 0.876–0.966), sFlt-1/PlGF ratio (OR 1.039, 95%CI 1.002– 1.078), baseline perfusion index (OR 0.221, 95%CI 0.101–0.485), T6 anesthesia level (OR 11.353, 95%CI 1.408–29.320), local anesthetic dose (OR 29.391, 95%CI 4.792–38.270), fetal weight (OR 1.004, P=0.045), and umbilical artery S/D ratio (OR 9.319, P<0.001). The nomogram demonstrated robust discrimination (training AUC 0.851; internal validation AUC 0.836; external validation AUC 0.810) and calibration (mean absolute errors: 0.013– 0.038). DCA confirmed clinical utility at a 45% risk threshold (net benefit 0.62), capturing 85% of events with 32% false positives. Conclusion: This validated prediction model accurately stratifies hypotension risk in preeclamptic parturients receiving neuraxial anesthesia. The nomogram facilitates targeted prophylactic interventions, optimizing resource allocation and maternal hemodynamic stability.
Keywords: Preeclampsia, Neuraxial anesthesia, Hypotension prediction, Nomogram validation, Obstetric Anesthesia
Received: 18 Jun 2025; Accepted: 26 Sep 2025.
Copyright: © 2025 Su, Chen, Ye and Lu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiuhong Ye, 25707476@qq.com
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