瘢痕子宫产前预测改良评分法的临床研究

The Clinical Study of the Modified Scoring Method For Scar Uterine

目的:建立瘢痕子宫产前预测改良评分法,评估剖宫产后再次妊娠的患者阴道试产结局的风险。方法:参考《头位分娩评分法》及《bishop评分法》,建立瘢痕子宫产前预测改良评分法(简称改良评分法),绘制并与Weitein's法、Flamm法的ROC曲线下面积进行比较。根据改良评分法的ROC曲线得到最佳截断点,并以此分析改良评分法分值与试产结局的关系。结果:改良评分法的ROC曲线下面积(0.988)明显大于Weitein's法(0.577)和Flamm法(0.616),3种诊断效率的比较,差异有统计学意义(P<0.05)。改良评分法的ROC曲线得到最佳截断点为18分,改良评分法评分>18分的阴道分娩率(94.8%)高于评分≤18分(5.6%),差异有统计学意义(P<0.05);阴道分娩组(93例)的评分(22.33±1.94分)明显高于剖宫产组(39例)的评分(14.35±1.87分),差异有统计学意义(P<0.05)。结论:改良评分法的诊断效率较传统方法高,能较好评估剖宫产后再次妊娠阴道试产的结局。

Objective： To propose a modified scoring system for uterine scar in order to evaluate the risk of vaginal birth after cesarean. Methods： To set up the modified scoring method to evaluate the improvement of scar uterus prenatal prediction by referencing the Lingluoda＇s cephalic presentation score method and bishop score method. Do the ROC curve of the modified scoring system and Weitein＇s method,Flamm method. And then compare the size of area under ROC curve. ROC curve was constructed to determine the best cutoff value. With the best cut off value,the relationship between the score and the trial outcome was analyzed. Results： The size of area under ROC curve of the modified scoring method（ 0. 988） was significantly higher than that of Weitein＇s method（ 0. 577） and Flamm method（ 0. 616） the difference was statistically significant（ P〈0. 05）. The best cut off value of the modified scoring method was 18,Score〉18 points of the rate of vaginal delivery（ 94. 8%） was higher than the score≤18（ 5. 6%）,the difference was statistically significant（ P 〈0. 05）; A significant difference was found between the Vaginal delivery group（ 93 cases,score 22. 33±1. 94） and the Cesarean group（ 39 cases,score14. 35±1. 87） on the score of patients scored with the modified scoring method（ P〈0. 05）. Conclusions： Compared to the traditional methods,the modified scoring method could improve the scar uterus prenatal evaluation and could predict the result of vaginal birth after cesarean better.