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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">fcmedicine</journal-id><journal-title-group><journal-title xml:lang="ru">Фундаментальная и клиническая медицина</journal-title><trans-title-group xml:lang="en"><trans-title>Fundamental and Clinical Medicine</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2500-0764</issn><issn pub-type="epub">2542-0941</issn><publisher><publisher-name>КемГМУ</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.23946/2500-0764-2025-10-4-88-100</article-id><article-id custom-type="elpub" pub-id-type="custom">fcmedicine-1109</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>АКУШЕРСТВО И ГИНЕКОЛОГИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>OBSTETRICS AND GYNECOLOGY</subject></subj-group></article-categories><title-group><article-title>Автоматизированный алгоритм прогнозирования риска рефрактерных послеродовых кровотечений</article-title><trans-title-group xml:lang="en"><trans-title>Automated algorithm for predicting the risk of refractory postpartum hemorrhage</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7099-4405</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Артымук</surname><given-names>Д. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Artymuk</surname><given-names>D. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Артымук Дмитрий Анатольевич, врач акушер-гинеколог</p><p>ул. Бакинская, 26, г. Москва, 115516, Россия</p></bio><bio xml:lang="en"><p>Dmitry A. Artymuk, MD, Obstetrician-Gynecologist</p><p>Bakinskaya Street, 26, Moscow, 115516, Russia</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7014-6492</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Артымук</surname><given-names>Н. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Artymuk</surname><given-names>N. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Артымук Наталья Владимировна, доктор медицинских наук, профессор, заведующая кафедрой акушерства и гинекологии им. проф. Г.А. Ушаковой</p><p>ул. Ворошилова, 22а, г. Кемерово, 650056, Россия</p></bio><bio xml:lang="en"><p>Natalya V. Artymuk, MD, Dr. Sci. (Medicine), Professor, Head of the Department of Obstetrics and Gynecology named after prof. G.A. Ushakova</p><p>Voroshilova Street, 22a, Kemerovo, 650056, Russia</p></bio><email xlink:type="simple">artymuk@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5641-5246</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Марочко</surname><given-names>Т. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Marochko</surname><given-names>T. Yu.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Марочко Татьяна Юрьевна, кандидат медицинских наук, доцент кафедры акушерства и гинекологии им. проф. Г.А. Ушаковой</p><p>ул. Ворошилова, 22а, г. Кемерово, 650056, Россия</p></bio><bio xml:lang="en"><p>Tatiana Yu. Marochko, MD, Cand. Sci. (Medicine), Associate Professor, Department of Obstetrics and Gynecology. prof. G.A. Ushakova</p><p>Voroshilova Street, 22a, Kemerovo, 650056, Russia</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3407-9365</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Аталян</surname><given-names>А. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Atalyan</surname><given-names>A. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Аталян Алина Валерьевна, кандидат биологических наук, старший научный сотрудник, руководитель функциональной группы информационных систем и биостатистики</p><p>ул. Тимирязева, д. 16, г. Иркутск, 664003, Россия</p></bio><bio xml:lang="en"><p>Alina V. Atalyan, Cand. Sci. (Biology), Senior Researcher, Head of the Functional Group of Information Systems and Biostatistics</p><p>Timiryazeva Street, 16, Irkutsk, 664003, Russia</p></bio><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2075-5529</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шибельгут</surname><given-names>Н. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Shibelgut</surname><given-names>N. M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Шибельгут Нонна Марковна, кандидат медицинских наук, заместитель главного врача по акушерской помощи</p><p>пр. Октябрьский, д. 22, г. Кемерово, 650066, Россия</p></bio><bio xml:lang="en"><p>Nonna M. Shibelgut, MD, Cand. Sci. (Medicine), Deputy Chief Physician for Obstetric Care</p><p>Oktyabrskiy Prospekt, 22, Kemerovo, 650066, Russia</p></bio><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7943-807X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Батина</surname><given-names>Н. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Batina</surname><given-names>N. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Батина Наталья Анатольевна, заведующая родовым отделением</p><p>пр. Октябрьский, д. 22, г. Кемерово, 650066, Россия</p></bio><bio xml:lang="en"><p>Natalia A. Batina, MD, Head of the Maternity Department</p><p>Oktyabrskiy Prospekt, 22, Kemerovo, 650066, Russia</p></bio><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7310-974X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Апресян</surname><given-names>С. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Apresyan</surname><given-names>S. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Апресян Сергей Владиславович, доктор медицинских наук, профессор кафедры акушерства и гинекологии</p><p>ул. Миклухо-Маклая, 6, г. Москва, 117198, Россия</p></bio><bio xml:lang="en"><p>Sergey V. Apresyan, MD, Dr. Sci. (Medicine), Professor, Department of Obstetrics and Gynecology</p><p>Miklukho-Maklaya Street, 6, Moscow, 117198, Russia</p></bio><xref ref-type="aff" rid="aff-5"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0003-5226-231X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Баинтуев</surname><given-names>Т. Г.</given-names></name><name name-style="western" xml:lang="en"><surname>Baintuev</surname><given-names>T. G.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Баинтуев Тимур Гомбожапович, лаборант-исследователь функциональной группы информационных систем и биостатистики</p><p>ул. Тимирязева, д. 16, г. Иркутск, 664003, Россия</p></bio><bio xml:lang="en"><p>Timur G. Baintuev, research laboratory assistant of the Functional Group of Information Systems and Biostatistics</p><p>Timiryazeva Street, 16, Irkutsk, 664003, Russia</p></bio><xref ref-type="aff" rid="aff-3"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Городская клиническая больница им. В.М. Буянова Департамента здравоохранения г. Москвы</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Buyanov City Clinical Hospital, Moscow Department of Health</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Кемеровский государственный медицинский университет</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Kemerovo State Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Научный центр проблем здоровья семьи и репродукции человека</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Research Centre for Family Health and Human Reproduction</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-4"><aff xml:lang="ru"><institution>Кузбасская областная клиническая больница имени С.В. Беляева</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Kuzbass Regional Clinical Hospital</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-5"><aff xml:lang="ru"><institution>Российский университет дружбы народов имени Патриса Лумумбы</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Peoples' Friendship University of Russia named after Patrice Lumumba</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2025</year></pub-date><pub-date pub-type="epub"><day>24</day><month>12</month><year>2025</year></pub-date><volume>10</volume><issue>4</issue><fpage>88</fpage><lpage>100</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Артымук Д.А., Артымук Н.В., Марочко Т.Ю., Аталян А.В., Шибельгут Н.М., Батина Н.А., Апресян С.В., Баинтуев Т.Г., 2025</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="ru">Артымук Д.А., Артымук Н.В., Марочко Т.Ю., Аталян А.В., Шибельгут Н.М., Батина Н.А., Апресян С.В., Баинтуев Т.Г.</copyright-holder><copyright-holder xml:lang="en">Artymuk D.A., Artymuk N.V., Marochko T.Y., Atalyan A.V., Shibelgut N.M., Batina N.A., Apresyan S.V., Baintuev T.G.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://fcm.kemsmu.ru/jour/article/view/1109">https://fcm.kemsmu.ru/jour/article/view/1109</self-uri><abstract><p>Послеродовое кровотечение (ПРК) остается значительным фактором материнской смертности и заболеваемости во всем мире. Смертельные исходы, связанные с ПРК, можно потенциально предотвратить путем эффективного прогнозирования и профилактики. Методы профилактики ПРК разработаны, регламентированы клиническими рекомендациями и нашли широкое применение в большинстве стран мира. Однако на сегодняшний день не существует эффективной системы для выявления пациенток с высоким риском ПРК, которым необходимы более строгие и научно обоснованные превентивные меры. Цель. Разработать и оценить информативность компьютерной программы (КП) прогнозирования риска рефрактерных ПРК, основанную на оценке анамнестических, клинических и лабораторных показателей. Материалы и методы. Обработка данных и построение моделей проводились с использованием Python 3.12 и библиотек pandas, shap, xgboost, sklearn и mlxtend. На отобранных признаках обучены ансамблевые модели экстремального градиентного бустинга (XGBoost). С помощью метода SHAP оценен вклад каждого признака в предсказательную способность моделей, визуализированный на столбчатых диаграммах и графиках типа «рой пчел». Тестирование разработанных моделей проведено на независимой выборке из 556 женщин (дизайн исследования − сплошное поперечное одномоментное исследование). Результаты. В результате проведенного исследования с использованием имеющихся баз данных из 178 параметров были отобраны 9 клинико-анамнестических (возраст пациентки, возраст менархе, паритет родов, рубец на матке, экстренное кесарево сечение, один параклинический (локализация плаценты по передней стенке матки по данным ультразвукового исследования) и четыре лабораторных (уровни HB, Ht, АЧТВ, фибриногена) параметров. которые были положены в основу двух автоматизированных моделей КП для ЭВМ «Прогнозирования риска послеродовых кровотечений». В модели, основанной на оценке клинико-анамнестических параметров, наиболее значимыми были наличие рубца на матке и локализация плаценты по передней стенке матки. В модели, основанной на оценке клинико-лабораторных параметров, наибольшее значение имели уровни Hb и Ht. Заключение. Разработаны две достаточно информативные модели программы «Прогнозирование риска рефрактерного послеродового кровотечения», основанные на оценке клинико-анамнестических (AUC – 0,69) и клинико-лабораторных данных (AUC – 0,74), применение которых может способствовать корректной стратификации пациенток в группу высокого риска ПРК с целью более дифференцированного подхода к проведению профилактических мероприятий.</p></abstract><trans-abstract xml:lang="en"><p>Postpartum hemorrhage (PPH) remains a significant factor in maternal mortality and morbidity worldwide. Fatal outcomes associated with PPH can be potentially prevented through effective prediction and prevention. Methods for PPH prevention have been developed, regulated by clinical guidelines and have found wide application in most countries of the world. However, to date, there is no effective system for identifying patients with a high risk of PPH who require more stringent and scientifically based preventive measures. Aim. To develop and evaluate the informativeness of a computer program (CP) for predicting the risk of refractory PPH based on anamnestic, clinical and laboratory parameters. Materials and methods. Data processing and model building were performed using Python 3.12 and pandas, shap, xgboost, sklearn and mlxtend libraries. Ensemble extreme gradient boosting (XGBoost) models were trained on the selected features. The SHAP method was used to estimate the contribution of each feature to the predictive ability of the models, visualized in bar charts and bee swarm graphs. The developed models were tested on an independent sample of 556 women (the study design was a continuous cross-sectional onetime study). Results. As a result of the conducted study using the available databases, 9 clinical and anamnestic (patient age, age at menarche, parity of delivery, uterine scar, emergency cesarean section, one paraclinical (placenta localization on the anterior wall of the uterus according to ultrasound examination data) and four laboratory (HB, Ht, APTT, fibrinogen levels) parameters were selected from 178 parameters. They were used as the basis for two automated models of the CP for the computer "Prediction of the risk of postpartum hemorrhage". In the model based on the assessment of clinical and anamnestic parameters, the most significant were the presence of a scar on the uterus and the localization of the placenta on the anterior wall of the uterus. In the model based on the assessment of clinical and laboratory parameters, the most important were the levels of Hb and Ht. Conclusion. Two sufficiently informative models of the program "Prediction of the risk of refractory postpartum hemorrhage" have been developed, based on the assessment of clinical and anamnestic (AUC – 0.69) and clinical and laboratory data (AUC – 0.74), the use of which can contribute to the correct stratification of patients in the high-risk group for PPH for the purpose of a more differentiated approach to preventive measures.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>рефрактерное послеродовое кровотечение</kwd><kwd>прогнозирование</kwd><kwd>риск</kwd><kwd>автоматизированный алгоритм</kwd></kwd-group><kwd-group xml:lang="en"><kwd>refractory postpartum hemorrhage</kwd><kwd>prognosis</kwd><kwd>risk</kwd><kwd>automated algorithm</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Mathewlynn S. J., Soltaninejad M., Collins S. L. 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