362例剖宫产后再妊娠妇女自然分娩影响因素Logistic回归模型构建及分析  

Construction and analysis of logistic regression models of factors influencing spontaneous delivery in 362 women with recurrent pregnancies after cesarean delivery

作　　者：李晨洁 梁菁苹[2] 王川红[2] LI Chenjie;LIANG Jingping;WANG Chuanhong(Department of Obstetrics and Gynecology,Dancheng Maternal and Child Health Hospital,Zhoukou,Henan 477150,China;Department of Obstetrics,Zhengzhou Maternal and Child Health Hospital,Zhengzhou,Henan 450000,China)

机构地区：[1]郸城县妇幼保健院妇产科,河南周口477150 [2]郑州市妇幼保健院产科,河南郑州450000

出　　处：《中国医学工程》2022年第11期29-34,共6页China Medical Engineering

摘　　要：目的分析剖宫产后再妊娠妇女自然分娩影响因素。方法选取郸城县妇幼保健院2019年12月至2021年2月期间收治的剖宫产后再妊娠妇女362例,参考自然分娩成功与否分为失败组(73例)与成功组(289例),收集全部研究对象临床资料,分析自然分娩的影响因素,构建Logistic回归预测模型。结果产前体质量指数、距上次剖宫产时长、家属态度、子宫下段厚度、胎儿体质量、胎头方位、子宫颈Bishop评分为剖宫产后再妊娠妇女自然分娩成功与否的影响因素(P<0.05);Logistic回归预测模型分析,产前体质量指数≥24 kg/m^(2)、距上次剖宫产时长≤3年、子宫下段厚度≤3.9 mm、胎儿体质量≥3.5 kg、枕后位与枕横位的胎头方位、子宫颈Bishop评分<6分为剖宫产后再妊娠妇女成功自然分娩的独立危险因素,试产家属态度为剖宫产后再妊娠妇女成功自然分娩的独立保护因素(P<0.05);似然比χ^(2)检验显示模型建立存在统计学意义;Waldχ^(2)检验显示模型构建有效;Hosmer-Lemeshow拟合优度检验显示模型拟合效果良好;受试者操作特征(ROC)曲线指出,Logistic回归预测模型预测剖宫产后再妊娠妇女成功自然分娩的AUC为0.901,95%CI为0.857~0.948,Z=10.587,P<0.001,敏感度为87.54%,特异度为79.45%。结论剖宫产后再妊娠妇女自然分娩与否与多个因素有关,其中产前体质量指数≥24 kg/m^(2)、距上次剖宫产时长≤3年、子宫下段厚度≤3.9 mm、胎儿体质量≥3.5 kg、枕后位与枕横位的胎头方位、子宫颈Bishop评分<6分为成功自然分娩的独立危险因素,试产家属态度为独立保护因素。【Objective】To analyze the factors influencing spontaneous delivery in women with recurrent pregnancies after cesarean delivery.【Methods】A total of 362 women admitted to our hospital during December 2019 to February 2021 for repregnancy after cesarean delivery were selected and divided into failure group(73 cases)and success group(289 cases)with reference to the success of spontaneous delivery,clinical data of all study subjects were collected,factors influencing spontaneous delivery were analyzed,and logistic regression prediction model was constructed.【Results】Antenatal body mass index,length of time since last cesarean delivery,family attitude,lower uterine segment thickness,fetal body mass,fetal head orientation,and cervical Bishop score were factors influencing the success of spontaneous delivery in women who had a second pregnancy after cesarean delivery(P<0.05).In the logistic regression prediction model,prenatal body mass index≥24 kg/m^(2),length of time since previous cesarean delivery≤3 years,lower uterine thickness≤3.9 mm,fetal mass≥3.5 kg,fetal head orientation in occipital posterior and occipital transverse positions,and cervical Bishop score<6 were independent risk factors for successful spontaneous delivery in women with recurrent pregnancy after cesarean delivery,and family attitude in trial of labor was an independent protective factor for successful spontaneous delivery in women with recurrent pregnancy after cesarean delivery(P<0.05);likelihood ratio chi-square test showed that there was a statistical significance in model building.Wald chi-square test showed valid model construction;Hosmer-Lemeshow goodness-of-fit test showed good model fit;ROC curve indicated that the AUC of logistic regression prediction model to predict successful spontaneous delivery in women with repeat pregnancy after cesarean delivery was 0.901,95%CI was 0.857 to 0.948,Z=10.587,P<0.001,with a sensitivity of 87.54%and a specificity of 79.45%.【Conclusion】Women with recurrent pregnancy after cesarean

关 键 词：剖宫产 再妊娠 自然分娩 LOGISTIC回归模型 影响因素 

分 类 号：R719.8[医药卫生—妇产科学]