国外阴道试产失败中转剖宫产预测模型在国内的适用性

Domestic applicability of overseas prediction models of transfer to cesarean delivery after failure of vaginal trial birth

目的探讨国外阴道试产失败中转剖宫产预测模型在国内的适用性,并初步探索影响中转剖宫产的危险因素。方法回顾性分析2011年1月—2017年8月本院妇产科所有单胎头位足月妊娠初产妇的病例资料。利用Tolcher、Levine、Burke模型分别进行预测风险计算及分析,并比较预测值及实际值。结果利用本院初产妇对Tolcher、Levine、Burke模型进行验证,其AUC ROC分别为0.659(95%CI 0.635-0.682),0.697(95%CI 0.656-0.738),0.623(95%CI 0.500-0.746)。上述三种模型在Hosmer-Lemeshow goodness-of-fit检验中显示其校准能力均良好(P>0.05)。对可能影响阴道试产中转剖宫产的临床参数进行单因素分析发现,当最佳临界值即孕妇年龄>26岁、身高≤160 cm、分娩孕周>40周、孕前BMI>21.3 kg/m~2、孕期增重>13 kg、合并疾病、羊水粪染及男性胎儿时初产妇中转剖的风险显著增加。结论上述三种模型均不适用于我院人群。在本研究中,产妇年龄、身高、BMI、孕期增重、孕周、引产方式、是否有羊水粪染、有无合并及并发症、新生儿体重、新生儿性别等影响了分娩方式。

Objective To explore the domestic applicability of overseas prediction models of transfer to cesarean delivery after failure of vaginal trial birth,and identify risk factors that may affecting cesarean section.Methods The clinical data of the full-term primiparas of singleton pregnancy and head delivery those were admitted to the department of obstetrics and gynecology of our hospital from January 2011 to August 2017 were retrospectively analyzed.The predicted risk was calculated and analyzed by Tolcher model,Levine model and Burke model,respectively,and the predicted value and actual value were compared.Results The primiparas were enrolled in verifying the Tolcher,Levine and Burke models in our hospital.The AUC of ROC were 0.659(95%CI:0.635-0.682),0.697(95%CI:0.656-0.738)and 0.623(95%CI:0.500-0.746),respectively.The three models also had reasonable calibration as depicted(P>0.05).The above three models showed good calibration ability in the Hosmer-Lemeshow goodness-of-fit test(P>0.05).Univariate analysis of the clinical parameters that may affect the incidence of cesarean delivery indicated that when the cut-off value was age>26 years old,height≤160cm,gestational age at delivery>40 weeks,pre-pregnancy BMI>21.3 kg/m2,pregnancy weight gain>13kg,had pregnancy-associated complications and meconium-stained amniotic fluid,and male fetus,the risk of cesarean was significantly increased.Conclusions The above three overseas model were not applicable to the population of our hospital.In this study,the older maternal age,the stature,BMI,the gestational weight gain,gestational weeks,mode of induction of labor,the presence of meconium-stained amniotic fluid,pregnancy-associated complications and gender of fetus are factors affecting delivery model.