初产妇阴道试产失败中转剖宫产风险预测模型的构建与验证

Construction and validation of a risk prediction model of intermediate cesarean section for primiparous women with failed vaginal delivery trial

目的构建并验证初产妇阴道试产失败中转剖宫产风险预测模型。方法回顾性收集于济宁医学院附属医院2019年1月至2020年12月分娩的所有产妇资料,将其分为建模组与验证组。对建模组样本进行单因素分析、二元logistic回归分析以筛选初产妇阴道试产失败中转剖宫产的影响因素,并根据各影响因素系数构建初产妇阴道分娩失败中转剖宫产风险预警模型;利用受试者工作特征(ROC)曲线和Hosmer-Lemeshow goodness-of-fit检验评估模型预测能力并选取验证组样本对模型进行验证。结果本研究共纳入6128例样本,建模组与验证组分别4290、1838例,中转剖宫产者1042例(17.00%)。单因素分析结果显示,经阴分娩组与中转剖宫产组产妇在年龄、工作、孕期增重、妊娠天数、分娩前体温、分娩时胎心情况、胎儿腹围、宫颈Bishop评分、胎膜早破情况、妊娠期疾病、引产方式、分娩镇痛、胎方位等方面差异均有统计学意义(P<0.05)。二元logistic回归分析结果显示,年龄、孕期增重、体温、妊娠合并疾病、妊娠天数、胎膜早破、羊水污染、引产、枕位异常是中转剖宫产的危险因素(OR=1.03~8.06,均P<0.05);身高、工作情况、宫颈Bishop评分、分娩镇痛是中转剖宫产的保护因素(OR=0.17~0.96,均P<0.05)。依据各影响因素构建的模型ROC曲线下面积为0.902(95%CI:0.89~0.92,P<0.001),最佳临界值为0.138,灵敏度与特异度分别为0.837、0.825,Hosmer-Lemeshow goodness-of-fit检验显示P=0.192。数据验证结果显示,模型ROC曲线下面积为0.917(95%CI:0.90~0.93,P<0.001),判别灵敏度和特异度分别为0.826、0.851。模型判断总正确率87.21%(1603/1838)。结论本研究所构建的初产妇阴道试产失败中转剖宫产风险预测模型临床预测效能良好,正确率较高。

ObjectiveTo construct and validate a prediction model for the risk of intermediate cesarean delivery for primiparous women with failed vaginal trial of labor.MethodsClinical data of 6128 pregnant women who gave birth in the Affiliated Hospital of Jining Medical College from January 2019 to December 2020 were collected.The puerpera was randomly divided into train set(n=4290)and validation set(n=1838).The factors influencing the conversion to cesarean section in primiparous women with failed vaginal trial of labor were analyzed with univariate and binary multivariate logistic regression,and a risk prediction model was established based on the influencing factors.The predictive power of the model was assessed by receiver operating characteristic(ROC)curve and the Hosmer-Lemeshow goodness-of-fit test in train set and validation set.ResultsAmong 6128 pregnant women 1042 cases failed in vaginal trial of labor and were transferred to cesarean section.Univariate analysis showed age,occupation,gestational weight gain,days of gestation,body temperature before delivery,fetal heart condition at delivery,fetal abdominal circumference,Bishop score,premature rupture of membranes,gestational illness,mode of induction of labor,labor analgesia,and fetal orientation were significantly associated with converting to cesarean delivery(all P<0.05).The multivariate binary logistic regression analysis showed that the age,gestational weight gain,body temperature,gestational co-morbidities,days of gestation,premature rupture of membranes,amniotic fluid contamination,induction of labor,and abnormal occipital position were independent risk factors for intermediate cesarean delivery(OR=1.03-8.06,all P<0.05);while height,occupation,Bishop score,and labor analgesia were protective factors for intermediate cesarean delivery(OR=0.17-0.96,all P<0.05).A risk prediction model was constructed based on the risk factors and protective factors.In train set,the area under the ROC curve(AUC)of the model was 0.902(95%CI:0.89-0.92,P<0.001),with the best cutoff value of 0.138,the sensitivity and specificity were 0.837 and 0.825,respectively;and the Hosmer-Lemeshow goodness-of-fit test showed P=0.192.In validation set the AUC of the model was 0.917(95%CI:0.90-0.93,P<0.001),and the sensitivity and specificity were 0.826 and 0.851,respectively;the total correct rate of the model was 87.21%(1603/1838).ConclusionThe risk prediction model of failed vaginal trial of labor in primiparous women for intermediate cesarean delivery constructed in this study has good clinical prediction efficacy and high correctness rate.