剖宫产后再次妊娠行阴道试产分娩不良结局的危险因素及建立预测模型的临床价值

Risk factors for adverse outcomes of vaginal trial birth after cesarean section and clinical value of establishing predictive models

目的探讨影响剖宫产后再次妊娠行阴道试产(VBAC)分娩不良结局的危险因素,建立列线图预测模型,分析模型的临床应用价值。方法选取2019年1月至2020年6月承德市妇幼保健院收治的176例VBAC产妇作为研究对象。根据母婴结局情况分为不良结局组与良好结局组,采用多因素Logistic回归模型筛选不良结局的危险因素,构建列线图预测模型。结果VBAC产妇不良结局发生率为20.45%(36/176);多因素Logistic回归分析显示,年龄大、距前次剖宫产时间>5年、发生巨大儿是不良结局的危险因素(P<0.05);基于上述危险因素建立列线图预测模型,验证结果显示,受试者工作特征曲线下面积为0.865(95%CI:0.798~0.831),列线图校准曲线斜率接近1,Hosmer-Lemeshow拟合优度检验显示χ^(2)=8.746,P=0.364。结论基于VBAC分娩不良结局的危险因素建立的列线图预测模型具有良好的区分度与一致性,可为临床分娩方式的选择、并发症的预防提供参考。

Objective To analyze the risk factors that affect the adverse outcome of vaginal trial birth after cesarean section(VBAC)and establish a nomogram prediction model.Methods A total of 176 cases of VBAC parturients who gave birth in Chengde Maternal and Child Health Hospital from January 2019 to June 2020 were selected as the research objects.According to the maternal and infant outcomes,the puerperas were divided into the adverse outcome group and the good outcome group,multivariate Logistic regression model was used to screen the risk factors of adverse outcomes and construct a nomogram prediction model.Results The incidence of adverse maternal outcomes in VBAC was 20.45%(36/176).Multivariate Logistic regression analysis showed that elder age,more than 5 years after the previous cesarean section and macrosomia were the risk factors for adverse outcomes(P<0.05).Based on the above risk factors,a nomogram prediction model was established based on the above risk factors.The verification results showed that the area under the ROC curve was 0.865(95%CI:0.798-0.831),the slope of the nomogram calibration curve was close to 1,and the Hosmer-Lemeshow goodness of fit test showedχ^(2)=8.746,P=0.364.Conclusions The nomogram prediction model based on the risk factors of adverse maternal and infant outcomes of VBAC has good discrimination and consistency,and can provide certain reference value for the selection of clinical birth methods and the prevention of complications.