以Robson十分类法为基础的剖宫产率关联因素和预测效度  

Related factors of cesarean section and predictive validity based on Robson Ten-Group Classification System

作　　者：花静[1] 刘铭[1] 严晓玲[1] 曹志娟[1] 谭晶[1] 段涛[1] 

机构地区：[1]同济大学附属上海市第一妇婴保健院妇幼保健部,200042

出　　处：《中华围产医学杂志》2017年第2期104-109,共6页Chinese Journal of Perinatal Medicine

基　　金：国家自然科学基金（81402687）;上海市科学技术委员会医学重点项目（13411950700）;上海市卫生和计划生育委员会面上项目（201640060）

摘　　要：目的探讨Robson十分类法相关因素与刮宫产率的关联性，分析基于该分类法的剖宫产预测模型的有效性。方法回顾性分析同济大学附属上海市第一妇婴保健院2012年1月1日至2014年9月30日住院分娩的41295例产妇的临床资料。采用描述性流行病学方法，分析按Robson十分类法分类的产妇的剖宫产率。模型1为“产科因素（产次、剖宫产史、胎数、临产方式、胎位、是否早产）”，模型2为“产科因素（即模型1）＋人口学和严重程度（产妇年龄、是否进入重症监护病房抢救）”，模型3为“产科因素＋人口学和严重程度（即模型2）＋合并症和并发症（前置胎盘、胎盘早剥、慢性高血压／妊娠期高血压、子痫前期、。肾脏疾病、人类免疫缺陷病毒感染）”。采用多因素Logistic回归模型（将潜在混杂因素也纳入模型加以控制）分析Robson分类法相关变量与剖宫产率的相关性。采用受试者工作特性（receiver operating characteristic，ROC）曲线分析对剖宫产预测模型的有效性。结果（1）不同年龄、医疗保险情况、产次、胎次、胎位、分娩孕周的产妇，其总剖宫产率和临产前剖宫产率差异有统计学意义（P值均〈0．05）。（2）不同Robson分类的产妇中，以第2组（单胎头位初产，孕周≥37周，引产或临产前剖宫产）所占剖宫产率的构成比最高，为61．2％（11217／18322）；其次为第4组（单胎头位经产妇，无剖宫产史，孕周≥37周，引产或临产前刮宫产），为11．2％（2061／18322）。（3）产次、胎数、临产方式、剖宫产史、胎位和分娩孕周均与剖宫产存在关联；而在调整母亲年龄和参保情况、产科合并症，以及两者均调整后，关联性仍均具有统计学意义（P值均〈0．05）。（4）预测剖宫产模型1（产科因素）的ROC曲线下面积为0．867，95％CI：0．863～0．870；模型2（产科因素＋Objective To explore the relationship between the obstetric factors defined by Robson Ten-Group Classification System （RTGCS） and cesarean section rate （CSR）, and to evaluate the validity of predictive models established based on the RTGCS for cesarean section. Methods Clinical data of 41 295 cases delivered in Shanghai First Maternity and Infant Hospital from January 1, 2012 to September 30, 2014 were retrospectively collected. CSR of different groups categorized by the RTGCS was analyzed by descriptive epidemiological methods by three models. Model 1 was obstetrics factors （parity, history of cesarean section, number of fetus, mode of labor, fetal presentation and gestational age）; model 2 was obstetrics factors （model 1） ＋ demographic characteristics and severity （maternal age and with/without treatment in intensive care unit）; model 3 was defined as model 2＋ complications （placenta previa, placental abruption, chronic or gestational hypertension, preeclampsia, renal disease, or human immunodeficiency virus infection）. The relationship between obstetrics factors classified by the RTGCS and CSR was analyzed by the logistic regression model （the potential confounders were controlled）. The validity of predictive models was evaluated by analyzing the area under the receiver operative characteristic （ROC） curve. Results （1） There were statistical differences in total CSR and CSR before labor among those cases respectively grouped by age, medical insurance, parity, signal/multiple pregnancy, fetal presentation and gestational age （all P〈0.05）. （2） The recruited cases were categorized into ten groups according to the RTGCS and among them, the second group （single, cephalic presentation, nulliparous, ≥ 37 gestational weeks, induced labor or cesarean section before labor） accounted for most of the cesarean section cases （61.2%, 11 217/18 322）, followed by the fourth group （single, cephalic presentation, multiparous, no previous cesarean section,≥ 37 gestat

关 键 词：剖宫产术 妊娠并发症 疾病严重程度指数 预测 

分 类 号：R719.8[医药卫生—妇产科学]