瘢痕子宫阴道试产产前评分系统的临床研究

Clinical Study of Prenatal Scoring System for Trial Production of Scar Vagina

目的建立瘢痕子宫阴道试产产前评分系统(简称产前评分系统),用于评估剖宫产术后瘢痕子宫再次妊娠阴道试产的分娩结局及风险。方法选择2017年1月至2020年6月我院瘢痕子宫自愿选择阴道分娩、符合入选条件的单胎孕妇445例作为研究对象,进入产程后按照产前评分系统的各项观察指标予以评分并累计出总分,根据阴道试产成功与否及评分分值,绘制ROC曲线,找出最佳截断值。同时将该方法与Weitein法、Flamm法ROC曲线下面积进行比较,验证该评分系统的诊断效率。结果该产前评分系统ROC曲线下面积(0.945)明显大于Weitein法(0.759)及Flamm法(0.692),差异有统计学意义(P<0.05)。根据ROC曲线找出最佳截断值为12分,评分≥12分组阴道试产成功率(96.67%)明显高于<12分组(26.09%),差异有统计学意义(P<0.05),但两组在产后出血、新生儿窒息发生率方面差异无统计学意义(P>0.05)。结论瘢痕子宫阴道试产产前评分系统用于剖宫产术后经阴道分娩产前评估效果理想,能获得较高的预测敏感性、特异性,能较好评估剖宫产术后再次妊娠阴道试产的结局。

Objective To propose the prenatal scoring system for vaginal trial delivery of scar uterus(abbreviated as antenatal scoring system)to evaluate the delivery outcome and risk of vaginal trial delivery of scar uterus after cesarean section.Methods From January 2017 to June 2020,445 single-born pregnant women with scar uterus who voluntarily chose vaginal delivery and met the research conditions were selected as the research objects.After entering the stage of labor,the total score was accumulated according to the observation index of the scoring system.And draw the ROC curve to determine the best cutoff value according to whether the vaginal trial production was successful and the total score.The area under ROC curve of this method,weitein method and flamm method was compared to verify the diagnostic efficiency of this scoring system.Results The size of area under the ROC curve of the prenatal scoring system(0.945)was significantly larger than that of the Weitein method(0.759)and the Flamm method(0.692),difference was statistically significant(P<0.05).According to the ROC curve,the best cutoff value was 12 points.The success rate of vaginal trial delivery in the group with score≥12 points(96.67%)was significantly higher than that in the group with score<12 points(26.09%),difference was statistically significant(P<0.05).However,there was no significant difference in the incidence of postpartum hemorrhage and neonatal asphyxia between the two groups(P>0.05).Conclusion This prenatal scoring system can be used to evaluate the outcome of vaginal delivery after cesarean section with high sensitivity and specificity.It can better evaluate the outcome of vaginal trial after cesarean section.