摘要
目的建立国内粤东多地区剖宫产术后妊娠经阴道分娩模型,对模型预测效果分析及验证可行性。方法统计分析368例剖宫产术后再次妊娠阴道试产(TOLAC)孕妇的临床资料,其中根据TOLAC成功与否再分为VBAC(剖宫产术后再次妊娠阴道分娩)组280例和TOLAC失败行剖宫产组88例。收集研究对象基本资料,经单因素与多因素Logistic回归分析及受试者工作特征曲线(ROC)建立预测模型并验证模型可行性。再选取本院符合纳入标准的58例剖宫产术后再次妊娠行阴道试产的产妇作为模型内部验证组,及外院符合纳入标准的30例剖宫产术后再次妊娠行阴道试产的产妇作为模型外部验证组,通过本研究构建的预测模型进行成功率预测,与实际观测的结果进行比较,并通过Hosmer-Lemeshow检验评价该模型的预测性能。再对比VBAC与剖宫产组之间的妊娠结局。结果368例研究对象,阴道试产成功(VBAC)280例,中转剖宫产(TOLAC失败组)88例,实际成功率为76.09%。相比TOLAC失败组,VBAC组产时出血量少,产后住院时间短,住院费用少(P<0.05);两组产后24 h出血量、新生儿Apgar评分、新生儿窒息率、新生儿转科率、产褥感染率、产后中转ICU比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示:剖宫产术后妊娠经阴道分娩成功的影响因素包括入院时BMI、预测的胎儿体重、宫颈管消失、先露高低以及阴道分娩史。预测模型的预测效果好,模型预测模型敏感度为93.90%,特异度为61.40%。结论入院时BMI、预测的胎儿体重、宫颈管消失、先露高低以及阴道分娩史是阴道分娩成功的有利因素,利用该5项指标建立的剖宫产术后再次妊娠经阴道分娩的预测模型,具有较准确的预测能力,并得到了验证,该模型的建立可辅助剖宫产术后再次妊娠患者选择分娩方式,以期提高阴道试产的安全性。同时,瘢痕子宫再次妊娠经阴道分娩成功与
Objective To establish a vaginal delivery model of pregnancy after cesarean section in east Guangdong,analyze the prediction effect and verify the feasibility of the model.Methods The clinical data of 368 pregnant women with second vaginal delivery after cesarean section(TOLAC)were analyzed.According to the success of TOLAC,280 women were divided into VBAC group and 88 women were divided into TOLAC group.The basic data of the subjects were collected,and the prediction model was established by univariate and multivariate Logistic regression analysis and receiver operating characteristic curve(RoC),and the feasibility of the model was verified.Fifty-eight women who underwent vaginal trial birth again after cesarean section in our hospital meeting the inclusion criteria were selected as the internal verification group of the model,and 30 women who underwent vaginal trial birth again after cesarean section in other hospitals meeting the inclusion criteria were selected as the external verification group of the model.The success rate was predicted through the prediction model constructed in this study,and the results were compared with actual observations.The predictive performance of the model was evaluated by Hosmer-Lemeshow test.Pregnancy outcomes were compared between the VBAC and cesarean section groups.Results Among the 368 subjects,280 were successful vaginal birth(VBAC)and 88 were successful cesarean section(TOLAC failure group).The actual success rate was 76.09%.Compared with TOLAC failure group,VBAC group had less intrapartum blood loss,shorter postpartum hospital stay and lower hospitalization cost(P<0.05).There were no significant differences in 24 h postpartum blood loss,neonatal Apgar score,neonatal asphyxia rate,neonatal transfer rate,puerperal infection rate and postpartum ICU transfer between the two groups(P>0.05).Multivariate Logistic regression analysis showed that the factors influencing the success of vaginal delivery after cesarean section included BMI on admission,predicted fetal weight,disappe
作者
陈海菊
栗丽
杨卓凡
郑燕乐
陈琳莹
王玉婷
Chen Haiju;Li Li;Yang Zhuofan;Zheng Yanl;Chen Linying;Wang Yuting(Department of Obstetrics,The First Affiliated Hospital of Shantou University Medical College,Shantou 515000,China;Department of Obstetrics,Jieyang People's Hospital,Jieyang 522000,China;Department of Obstetrics,Puning People's Hospital Puning 515300,China)
出处
《实用妇科内分泌电子杂志》
2023年第21期45-50,共6页
Electronic Journal of Practical Gynecological Endocrinology
关键词
剖宫产术后妊娠经阴道分娩
妊娠结局
模型
预测
Vaginal delivery of pregnancy after cesarean section
Pregnancy outcome
The model
Forecast
