基于列线图模型分析影响新产程标准下孕足月胎膜早破经产妇试产失败的因素

Analysis of factors affecting the failure of trial delivery of pregnant women with term premature rupture of membranes under the new labor process standard based on nomogram model

目的探讨新产程标准下孕足月胎膜早破经产妇试产的产程特点,并分析试产失败的影响因素。方法回顾性选取2019年5月至2022年2月于北京市朝阳区妇幼保健院产科分娩的192例孕足月胎膜早破经产妇作为研究组,另选择同期分娩的157例自然临产经产妇作为对照,对比两组产妇产程特点及干预措施。依据研究组产妇试产情况将其分为试产成功组(n=137)和试产失败组(n=55),对比两组产妇临床资料,多因素分析采用Logistic回归模型,构建反向传播(BP)神经网络模型,并评价模型的区分度和准确性。结果与对照组比较,研究组产妇活跃期时间明显减少,第一产程和第二产程则显著延长(P<0.05),会阴侧切率显著增加(P<0.05)。试产成功与失败产妇在年龄、孕前BMI、产前BMI、胎儿体质量、宫缩乏力、距前次剖宫产年限、产程停滞及受教育程度方面差异显著(P<0.05)。产妇年龄≥35岁、胎儿体质量≥3.5 kg、宫缩乏力、产前BMI≥30 kg/m^(2)、产程停滞是孕足月胎膜早破经产妇试产失败的独立危险因素(P<0.05),BP神经网络模型预测的区分度较好,准确性较高。结论孕足月胎膜早破经产妇活跃期时间明显减少,第一产程和第二产程则显著延长,产妇年龄、胎儿体质量、宫缩乏力、产前BMI及产程停滞均为产妇试产失败的影响因素。

Objective To explore the characteristics of labor process of pregnant women with full-term premature rupture of membranes under the new labor process standard,and analyze the influencing factors of trial delivery failure.Methods 192 full-term pregnant women with premature rupture of membranes who delivered in obstetrics department of Beijing Chaoyang Maternal and Child Health Hospital from May 2019 to February 2022 were selected retrospectively as the study group,and another 157 cases of spontaneous parturient women who delivered at the same time were selected as the control.The characteristics of labor process and intervention measures between the control group and the observation group were compared.The study group was divided into the successful trial delivery group(n=137)and the failed trial delivery group(n=55)according to the trial delivery situation.The clinical data the successful trial group and the failed trial group were compared,and the Logistic regression model was used for multivariate analysis,the back propagation(BP)neural network model was constructed,and the discrimination and accuracy of the model were evaluated.Results The time of active period in the study group was significantly reduced compared with the control group,while the first stage of labor and the second stage of labor were prolonged significantly(P<0.05),and the rate of lateral perineal resection was significantly increased(P<0.05).There were significant differences in age,pre pregnancy BMI,prenatal BMI,fetal body mass,uterine atony,the number of years from the previous cesarean section,labor stagnation and education level between the successful and failed parturients(P<0.05).Maternal age≥35 years old,fetal body mass≥3.5 kg,uterine asthenia,prenatal BMI≥30 kg/m^(2) and labor stagnation were independent risk factors for the failure of trial delivery of pregnant full-term premature rupture of membranes(P<0.05).The BP neural network model had good discrimination and high accuracy.Conclusion The active period of pregnant full-term premature rupture of membranes was significantly reduced,and the first and second stages of labor were prolonged significantly.maternal age,fetal body mass,uterine asthenia,prenatal BMI and labor stagnation were the influencing factors of maternal trial delivery failure.