肥胖孕妇阴道试产失败中转剖宫产预测模型的建立

Establishment of a predictive model for the conversion of obese pregnant women to cesarean section due to failed vaginal trial labor

目的筛选肥胖孕妇阴道试产失败中转剖宫产(简称“中转剖”)的影响因素,构建预测模型。方法回顾性分析厦门大学附属妇女儿童医院2020年1月至2021年12月收治的164例肥胖孕妇为研究对象。采用单因素分析、多因素logistic回归分析筛选中转剖的影响因素,建立预测模型。利用受试者工作特征(ROC)曲线和Hosmer-Lemeshow检验模型预测性能。结果20.12%肥胖产妇发生中转剖。单因素分析表明,妊娠前身体质量指数(BMI)、临产前BMI、孕次、产次、缩宫素引产、胎儿宫内窘迫、巨大儿与中转剖有关(P<0.05)。多因素logistic回归分析表明临产前BMI、胎儿宫内窘迫是中转剖的独立危险因素(P<0.05),产次是保护因素(P<0.05)。曲线下面积(AUC)为0.797,95%CI为(0.760~0.888),有良好预测价值。通过HosmerLemeshow拟合优度检验结果显示模型的拟合程度较好(P>0.05)。结论本研究构建的预测模型具有一定的临床实用性,可为临床医护人员指导产妇选择恰当的分娩方式提供依据。

Objective To screen the influencing factors of the conversion of obese pregnant women to cesarean section due to failed vaginal trial labor,and to construct a predictive model.Methods A retrospective analysis was conducted on 164 obese pregnant women admitted to Women and Children’s Hospital,Xiamen University from January 2020 to December 2021.Univariate analysis and multivariate logistic regression analysis were used to screen the influencing factors of conversion to cesarean section and establish a predictive model.The receiver operating characteristic(ROC)curve and Hosmer-Lemeshow were used to test the predictive performance of the model.Results 20.1% of obese pregnant women experienced a conversion to cesarean section.Univariate analysis showed that pre-pregnancy body mass index(BMI),prenatal BMI,gravidity,parity,oxytocin-induced labor,fetal distress in utero,and macrosomia were associated with the conversion to cesarean section(P<0.05).Multivariate logistic regression analysis showed that prenatal BMI and fetal distress in utero were independent risk factors for conversion to cesarean section(P<0.05).Parity was a protective factor(P<0.05).The area under the curve(AUC)was 0.797,with a 95%CI of 0.760-0.888,which had a good predictive value.The results of the Hosmer-Lemeshow goodness of fit test showed that the model had a good degree of fit(P>0.05).Conclusion The predictive model constructed in this study has certain clinical practicality and can provide a basis for clinical medical staff to guide pregnant women to choose appropriate del ivery methods.