新产程标准下阴道试产失败中转剖宫产的影响因素分析及风险预测模型构建

Analysis of influencing factors and construction of risk prediction model for vaginal trial labor failure convert to cesarean section under the new labor process standard

目的分析新产程标准下阴道试产失败中转剖宫产的影响因素,构建风险预测的列线图模型。方法选取2021年1月1日至12月31日在南京医科大学附属泰州人民医院产科阴道试产的1888例产妇作为研究对象,依据是否发生阴道试产失败中转剖宫产将产妇分为中转剖宫产组(352例)与阴道分娩组(1536例),收集并比较两组产妇的临床资料。采用多因素Logistic回归模型分析阴道试产失败中转剖宫产的影响因素,建立列线图模型,并绘制受试者工作特征曲线及校准曲线对该模型进行验证。结果阴道分娩组与中转剖宫产组产次、身高、孕前体质量指数(BMI)、住院时间、胎儿腹围、孕妇焦虑评分、妊娠压力评分、人工破膜、无痛分娩、导乐分娩、妊娠期高血压疾病、接受辅助生殖技术、巨大儿、羊水过多、胎膜早破、缩宫素引产、水囊引产、胎心监护分类为Ⅱ类方面比较,差异均有统计学意义(P<0.05)。产次≥1次、身高高、人工破膜、无痛分娩、导乐分娩是阴道试产失败中转剖宫产的独立保护因素(P<0.05);妊娠期高血压疾病、巨大儿、羊水过多、孕前BMI升高、住院时间延长、胎膜早破、缩宫素引产、水囊引产、胎心监护分类为Ⅱ类、胎儿腹围增加、孕妇焦虑评分升高和妊娠压力评分升高是阴道试产失败中转剖宫产的独立危险因素(P<0.05)。阴道试产失败中转剖宫产预测模型的曲线下面积为0.90。当列线图总分≥275.60分时,预测阴道试产失败中转剖宫产的灵敏度为84.4%,特异度为79.0%。结论新产程标准下阴道试产失败中转剖宫产风险预测模型有较高的准确率,可以应用并降低阴道试产失败中转剖宫产的风险,提高产妇和新生儿的安全性。

Objective To analyze the influencing factors of vaginal trial labor failure convert to cesarean section under the new labor process standard,and to construct a nonogram model for risk prediction.Methods A total of 1888 parturients undergoing vaginal trial labor in the department of obstetrics of the Affiliated Taizhou People's Hospital of Nanjing Medical University from January 1 to December 31,2021 were selected as the study subjects.According to whether vaginal trial labor failed,the parturients were divided into mid-transfer cesarean section group(352 cases)and vaginal delivery group(1536 cases).The clinical data of the two groups were collected and compared.Multivariate Logistic regression model was used to screen the influencing factors of vaginal trial labor failure convert to cesarean section delivery,a nomogram model was established,and draw receiver operating characteristic curve and calibration curve to validate the model.Results There were statistically significant differences between the vaginal delivery group and the transfer cesarean section group on terms of parity,height,pregnancy body mass index(BMI),length of hospital stay,fetal abdominal circumference,maternal anxiety score,gestational pressure score,artificial rupture of membranes,painlessness delivery and Doula delivery,hypertensive disorders complicating pregnancy,accepting assisted reproductive technology,macrosomia,polyhydramnios,premature rupture of membranes,oxytocin induced abortion,water sac induced abortion and fetal heart rate monitoring classified as class Ⅱ(P<0.05).Parity,height,artificial rupture of membranes,painlessness delivery and Doula delivery are independent protective factors for the incidence of cesarean section.Hypertensive disorders complicating pregnancy,macrosomia,polyhydramnios,elevated BMI before pregnancy,prolonged length of hospital stay,premature rupture of membranes,oxytocin induced abortion,water sac induced abortion,fetal cardiac monitoring classified as class Ⅱ,increased fetal abdominal circumference,increased maternal anxiety score and increased gestational pressure score were independent risk factors for the incidence of vaginal trial labor failure convert to cesarean section.The area under the curve of the prediction model for vaginal trial labor failure convert to cesarean section was 0.90.When the total score of the nomogram was≥275.60,the sensitivity of predicting vaginal trial labor failure convert to cesarean section was 84.4%,and the specificity was 79.0%.Conclusion The risk prediction model of vaginal trial labor failure convert to cesarean section under the new labor process standard has a high accuracy,which can be used to reduce the risk of vaginal trial labor failure convert to cesarean section and improve the safety of parturients and newborns.The risk prediction model for vaginal trial labor failure convert to cesarean section under the new labor criteria has high accuracy and can be applied and reduce the risk of vaginal trial labor failure convert to cesarean section to improve maternal and neonatal safety.