Development of a predictive model for maternal satisfaction with epidural analgesia based on perinatal complications

Abstract Maternal satisfaction with epidural analgesia (MSEA) is influenced by multiple factors. This study aimed to develop and validate a predictive model for MSEA based on perinatal complications associated with epidural analgesia, providing a tool for personalized analgesia protocols and enhanced childbirth experiences. We retrospectively analyzed clinical data from 2,221 parturients admitted to Fujian Maternity and Child Health Hospital (July 2023–March 2024). The cohort was randomly divided into training (1,555 cases) and internal validation (666 cases) sets at a 7:3 ratio. In the training set: Statistically significant variables were screened using Least Absolute Shrinkage and Selection Operator (LASSO) regression. Collinearity diagnostics assessed variable relationships. Univariate and multivariate logistic regression identified independent predictors of MSEA and constructed a nomogram. Validation: Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), concordance index (C-index), calibration curves, Hosmer-Lemeshow test, and decision curve analysis (DCA) for clinical net benefit. The prevalence of maternal dissatisfaction with epidural analgesia was 15.80% (351/2,221). Independent risk factors included fever (OR = 1.83, 95% CI: 1.26–2.62, P = 0.001), nausea and vomiting (OR = 1.79, 95% CI: 1.23–2.58, P = 0.002), puncture pain (OR = 1.78, 95% CI: 1.31–2.43, P < 0.001), lumbar soreness (OR = 10.89, 95% CI: 6.74–18.64, P < 0.001), and lower limb motor impairment (OR = 9.70, 95% CI: 4.95–21.96, P < 0.001). The nomogram showed strong discrimination, with AUCs of 0.789 (95% CI: 0.764–0.814; training) and 0.764 (95% CI: 0.720–0.809; validation). Calibration curves and Hosmer-Lemeshow test ( P = 0.205) indicated excellent agreement between predicted and observed outcomes. DCA confirmed clinical utility. Fever, nausea and vomiting, puncture pain, lumbar soreness, and lower limb motor impairment independently predict maternal dissatisfaction with epidural analgesia ( P < 0.05). The validated nomogram based on perinatal complications effectively predicts MSEA, demonstrating robust discrimination and calibration.