改良VBAC评分法在剖宫产后阴道试产中的应用

Application of modified VBAC scoring method in vaginal trial delivery after cesarean section

目的探讨改良VBAC评分法在剖宫产后阴道试产中的应用价值。方法选择2014年1月至2019年10月沧州市中心医院产科住院的519例瘢痕子宫再妊娠有阴道分娩要求的孕妇作为研究对象。参考国外的评分方法,即Flamm、Gonen、Grobman、Metz的评分法,进行改良,建立新的评分法,选择与阴道分娩结局相关的各个因素,分为临产前评分及临产后评分两项,利用ROC曲线得到最佳截断值,分析改良的VBAC评分法与试产结局的关系。结果改良的VBAC评分法与Flamm、Metz法比较,ROC曲线下面积(0.979)明显大于Metz法(0.711)、Flamm法(0.623),三者相比,差异具有统计学意义(P<0.05),改良的VBAC评分法得到的最佳截断值为16,大于截断值与小于截断值的阴道分娩率相比,差异有统计学意义(P<0.05);对比分析分值大于截断值的阴道分娩组与非瘢痕子宫阴道分娩组的妊娠结局,肩难产、产后出血、产褥病率、子宫切除、新生儿窒息、产后住院天数比较,差异无统计学意义(P>0.05)。会阴侧切、阴道助产例数较对照组增高,差异具有统计学意义(P<0.05)。结论改良VBAC评分法与其它预测方法比较,能较好的预测剖宫产后阴道分娩的成功率,有一定的临床应用价值。

Objective To explore the application value of modified VBAC scoring method in vaginal trial delivery after cesarean section.Methods From January 2014 to October 2019,519 pregnant women who were hospitalized in the obstetrics department of Cangzhou central hospital were selected as the study objects.According to the scoring methods of foreign countries,Flamm,Gonen,Grobman and Metz,the new scoring method was established.The factors related to the outcome of vaginal delivery were selected and divided into pre-partum score and post-partum score.The ROC curve was used to obtain the best cutoff value,and the relationship between the improved VBAC score and the trial delivery outcome was analyzed.Results Compared with the Flamm and Metz methods,the improved VBAC score was significantly larger than the Metz method(0.711)and the Flamm method(0.623),with statistically significant differences(P<0.05).The optimal cutoff value obtained by the modified VBAC score was 16,with statistically significant differences(P<0.05).There was no statistically significant difference in the pregnancy outcomes,shoulder dystocia,postpartum hemorrhage,puerperal morbidity,hysterectomy,neonatal asphyxia and postpartum hospital stay between the non-scarred uterine vaginal delivery group and vaginal delivery group with cutoff value higher than 16(P>0.05).The number of perineal side-cut and vaginal midwifery was higher than that of the control group,with statistically significant differences(P<0.05).Conclusions Compared with other prediction methods,the modified VBAC scoring method can better predict the success rate of vaginal delivery after cesarean section,with certain clinical application value.