预测瘢痕子宫阴道试产失败的风险列线图模型建立

Establishment of risk nomogram model for predicting the failure of vaginal delivery of scar uterus

目的:建立预测瘢痕子宫阴道试产失败的风险列线图模型。方法:回顾性分析2017年12月至2019年12月我院收治的剖宫产术后瘢痕再次妊娠的163例孕妇的临床资料,分析阴道试产失败的独立危险因素,建立风险列线图模型,并对模型的预测性及准确度进行验证。结果:年龄≥35岁(OR=2.983,95%CI:1.108~8.026)、产前BMI≥30 kg/m~2(OR=6.461,95%CI:2.263~18.445)、助产士工作年限<10年(OR=8.080,95%CI:2.163~30.187)、剖宫产间隔时间<3年(OR=3.651,95%CI:1.341~9.938)、瘢痕处压痛(OR=5.723,95%CI:2.028~16.155)、子宫下段瘢痕厚度<4mm(OR=2.895,95%CI:1.124~7.455)及婴儿体质量≥3.5 kg(OR=5.603,95%CI:2.140~14.670)是预测瘢痕子宫阴道试产失败的独立危险因素。风险列线图预测模型预测值同实测值基本一致,Bootstrap内部验证显示C-index高达0.903(95%CI:0.880~0.926)。结论:风险列线图模型有较高的预测效能和精确度,对临床筛查高危产妇和采取更合理的分娩方式具有指导意义。

Objective:To establish a risk nomogram model for predicting the failure of vaginal delivery of scar uterus.Methods:The clinical data of 163 pregnant women with scar pregnancy after cesarean section in our hospital from December 2017 to December 2019 were retrospectively analyzed.The independent risk factors for the failure of vaginal delivery were analyzed,the risk nomogram model was established,and the prediction and accuracy of the model were verified eventually.Results:Age≥35 years(OR=2.983,95%CI:1.108-8.026),prenatal BMI≥30 kg/m^2(OR=6.461,95%CI:2.263-18.445),midwife’s working years<10 years(OR=8.080,95%CI:2.163-30.187),interval time between cesarean section<3 years(OR=3.651,95%CI:1.341-9.938),pain in scar(OR=5.723,95%CI:2.028-16.155),thickness of scar in the lower segment of uterus<4 mm(OR=2.895,95%CI:1.124-7.455)and infant body weight≥3.5 kg(OR=5.603,95%CI:2.140-14.670)were the independent risk factors for the failure of vaginal delivery with scar uterus.The predicted value of risk nomogram prediction model was basically consistent with the measured value.Bootstrap internal verification showed that the C-index was as high as 0.903(95%CI:0.880-0.926).Conclusion:The risk nomogram model has high prediction efficiency and accuracy,which has guiding significance for screening of high-risk pregnant women and taking more reasonable delivery mode in clinic.