剖宫产术后经阴道分娩预测模型的建立

目的:建立适用于本地区的剖宫产术后阴道分娩(VBAC)预测模型,增加VBAC的安全性。方法:通过对330例剖宫产术后阴道试产(TOLAC)孕妇进行前瞻性队列研究,采集试产孕妇的临床资料,运用Logistic多因素回归分析构建VBAC预测模型。结果:①研究样本阴道试产成功266例,阴道试产失败再次剖宫产分娩64例,阴道分娩成功率为80.6%。在VBAC成功组里有2例孕产妇子宫破裂,无产妇或者新生儿死亡等严重病例。②VBAC成功率=1-exp(w)/[1+exp(w)];W=20.486+0.096×年龄(岁)-0.153×身高(cm)+0.128×孕期增加体质量(kg)-1.516×阴道分娩史-0.008×入院时子宫颈消失(%)-0.938×引产(阴道分娩史:0否,1是;引产:0否,1是)。③VBAC预测模型的灵敏度、特异度及总判断率分别为97.7%、20.3%及82.6%。结论:VBAC预测模型对VBAC具有较准确的预测能力,能够提高VBAC的安全性。

Establishment of a Prediction Model for Vaginal Delivery after Cesarean Section

Objective:To propose a prediction model for vaginal delivery after cesarean section to increase the safety of vaginal delivery after cesarean section.Methods:A prospective cohort study of 330 pregnant women who underwent trial of labor after cesarean section(TOLAC) was carried out.The prediction model was proposed by collecting clinical data of the pregnant women and using logistic multivariate regression analysis.Results:①A total of 266 women had successful vaginal delivery while 64 women failed.Vaginal delivery success rate was 80.6%.In the vaginal birth after cesarean section(VBAC) group,rupture of uterus happened in 2 pregnant women,no maternal or neonatal deaths and other serious cases existed.②VBAC success rate =1-exp(w)/[1+exp(w)];W=20.486+0.096×age(y)-0.153×height(cm)+0.128×pregnancy weight gain(kg)-1.516×any prior vaginal delivery(no=0/yes=1)-0.008×dilatation of cervix(%)-0.938×induced labour(no=0/yes=1).③The sensitivity,specificity and total judgment rate were 97.7%、20.3% and 82.6%,respectively.Conclusions:VBAC prediction model can predict vaginal delivery after cesarean section accurately,and thus it can improve the safety of vaginal delivery after cesarean section.