分娩时会阴切开决策影响因素预测模型的构建

目的 探讨影响会阴切开决策的因素,并建立Logistic回归预测模型。方法 选取2018年4月—8月在上海市某三级甲等医院进行阴道分娩的685名产妇作为研究对象,将会阴切开组（n=307）和非会阴切开组（n=378）的各项指标进行对比,通过Logistic回归分析建立风险预测模型,并通过ROC曲线检验模型的预测效果。结果 本研究共纳入会阴长度、会阴弹性、会阴水肿、阴道裂伤、估计胎儿体重、产妇配合程度、宫缩情况以及助产士的助产年限8个影响因素构建风险预测模型。本模型的ROC曲线下面积为0.932,当最佳界值为0.370时,灵敏度为0.883,特异度为0.802。结论 本模型预测效果良好,适用于临床实践,在第二产程应用此模型可为临床助产士决策行会阴切开提供客观参考。

Establishment of predictive model of midwives' decision on episiotomy during childbirth

Objective To investigate the risk factors of episiotomy and to establish the logistic regression model.Methods Totally 685 women with singleton pregnancy with vaginal delivery in a tertiary hospital were selected from April to August,2018. Multiple indicators of episiotomy group （n=307） and non episiotomy group （n=378） were compared. Logistic regression was used to establish a risk prediction model,and the model power and its accuracy were evaluated by receiver operating characteristic.Results The study finally included length of perineum,perineum resilience,perineum edema,colpoperineal laceration,estimation of fetal weight,cooperation of women,uterine contraction and work experience of midwives to construct the risk prediction model. This model's area under curve of receiver operating characteristic was 0.932. When the best predicted probability was 0.496,the sensitivity and specificity of the logistic model were 0.883 and 0.802,respectively.Conclusion The risk prediction model has satisfactory prediction effects and can be completed at the second stage of labor.