疤痕子宫再妊娠经阴道分娩的影响因素及预测价值分析

Analysis of Influencing Factors and Predictive Value of Vaginal Delivery in Scarred Uterus Re-Pregnancy

目的:探讨疤痕子宫再妊娠经阴道分娩的影响因素及预测价值。方法:回顾性选取2021年1月至2023年6月蚌埠市第一人民医院收治的109例疤痕子宫再妊娠孕妇,根据分娩结局进行分组,阴道分娩成功组78例,失败组31例。比较两组孕妇基线资料及妊娠晚期肌层厚度差异,使用Logis-tic逐步回归分析疤痕子宫再妊娠阴道分娩的影响因素,受试者工作特征(ROC)曲线分析影响因素与疤痕子宫再妊娠阴道分娩的预测价值。结果:两组孕妇年龄、孕周、孕次、距离上次剖宫产时间、产前胎儿评估体重、是否临产入院及文化程度对比无明显差异(P>0.05);产前体质量指数(BMI)、宫颈Bishop评分和肌层厚度经比较,差异有统计学意义(P<0.05)。Logistic回归分析结果显示产前BMI、宫颈Bish-op评分和肌层厚度为疤痕子宫再妊娠分娩结局的影响因素(P<0.05)。ROC曲线分析结果显示,产前BMI、宫颈Bishop评分和肌层厚度预测疤痕子宫再妊娠经阴道分娩的曲线下面积(AUC)分别为0.669、0.691、0.670,三者联合预测的AUC为0.806,显著高于单独指标(Z=2.885、3.604、3.296,P=0.004、<0.001、0.001),敏感度为90.32%,特异度为61.54%。结论:产前BMI、宫颈Bishop评分和肌层厚度为疤痕子宫再妊娠经阴道分娩结局的影响因素,可作为阴道分娩结局的预测指标。

Objective:To investigate the influencing factors and predictive value of vaginal delivery in scarred uterus re-pregnancy.Methods:A retrospective study was conducted on 109 pregnant women with scarred uterus re-pregnancy who were admitted to the First People's Hospital of Bengbu from January 2021 to June 2023.According to the delivery outcome,they were divided into two groups:vaginal delivery success group(n=78)and failure group(n=31).The baseline data and late pregnancy myometrial thickness of the pregnant women in the two groups were compared.Logistic regression analysis was used to analyze the influen-cing factors of vaginal delivery in scarred uterus re-pregnancy,and the receiver operating characteristic(ROC)curve was used to analyze the predictive value of the influencing factors for vaginal delivery in scarred uterus re-pregnancy.Results:There was no significant difference in age,gestational week,parity,interval from previous cesarean section,estimated fetal weight before delivery,admission in labor,and education level between the two groups(P>0.05).The pre-pregnancy body mass index(BMI),cervical Bishop score,and myometrial thickness were significantly different between the two groups(P<0.05).Logistic regression analy-sis showed that pre-pregnancy BMI,cervical Bishop score,and myometrial thickness were the influencing fac-tors of delivery outcome in scarred uterus re-pregnancy(P<0.05).The ROC curve analysis showed that the areas under the curve(AUC)of pre-pregnancy BMI,cervical Bishop score,and myometrial thickness for predicting vaginal delivery in scarred uterus re-pregnancy were 0.669,0.691,and 0.670,respectively.The AUC of the combined prediction of the three indicators was 0.806,which was significantly higher than that of the single indicators(Z=2.885,3.604,3.296,P=0.004,<0.001,0.001).The sensitivity was 90.32%,and the specificity was 61.54%.Conclusion:Pre-pregnancy BMI,cervical Bishop score,and myometrial thickness are the influencing factors of vaginal delivery outcome in scarred uterus re-pregnancy and can be used as predictive indicators of vaginal delivery outcome.