初产妇阴道试产结局影响因素分析及预测模型构建  被引量:1

Analysis of influencing factors and construction of prediction model for the outcome of vaginal trial of labor in primipara

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作  者:陈美文 葛莉娜[1] CHEN Meiwen;GE Li’na(Gynecology and Obstetrics Department,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区:[1]中国医科大学附属盛京医院妇产科,沈阳110004

出  处:《中国妇产科临床杂志》2024年第2期145-149,共5页Chinese Journal of Clinical Obstetrics and Gynecology

基  金:辽宁省教育厅科学研究经费项目(LJKR0279)。

摘  要:目的探讨影响初产妇阴道试产结局的影响因素,并根据影响因素构建初产妇阴道试产预测模型。方法按1∶1选取同期经阴道试产,试产结局为异常分娩(包括阴道手术助产和中转剖宫产)和正常分娩足月单胎初产妇的临床资料共626例进行回顾性病例对照研究。对可能影响试产结局的相关因素进行单因素分析,将有统计学意义的变量进行logistic回归分析,根据回归结果构建预测模型。结果多因素logistic回归分析显示,胎膜早破、分娩镇痛、临产前体质指数、宫高、脐带绕颈、胎儿头围、胎儿腹围为异常分娩发生的独立危险因素(OR>1,P<0.05),孕妇身高和宫颈Bishop评分为异常分娩的独立保护性因素(OR<1,P<0.05)。依据偏回归系数构建模型方程,ROC曲线下面积为0.839(95%CI:0.8018~0.8754),模型通过Homer-Lemeshow检验,有较好的区分度和校准度(χ^(2)=0.212,P=0.121)。结论影响初产妇异常分娩发生的因素较多,根据独立影响因素构建的预测模型对初产妇异常分娩的发生有一定预测能力,可对孕妇进行产前评估。Objective To explore the influencing factors on the outcome of vaginal trial of labor in primipara,and build a prediction model based on the influencing factors.Methods A retrospective case-control study was conducted on 626 cases of parturients with abnormal delivery(including vaginal operation and cesarean section)as the case group and normal delivery as the control group.The relevant factors that may affect the trial production outcome were taken as independent variables,and the trial production outcome was taken as dependent variable.Logistic regression analysis was performed on the variables with statistical significance,and a prediction model was built according to the Logistic regression results.Results Multivariate Logistic regression analysis showed that premature rupture of membranes,analgesia,pre-labor body mass index,uterine height,umbilical cord around neck,fetal head circumference and fetal abdominal circumference were independent risk factors for abnormal delivery(OR>1,P<0.05),and maternal height and cervical Bishop score were independent protective factors for abnormal delivery(OR<1,P<0.05).According to the partial regression coefficient,the model equation was constructed,AUC of the model predicted the occurrence of abnormal parturiency was 0.839(95%CI:0.8018~0.8754).The model passed the Homer-Lemeshow test(χ^(2)=0.212,P=0.121),and had good differentiation and calibration degree.Conclusions There are many factors affecting the occurrence of abnormal delivery in primipara.The prediction model based on independent factors can predict the occurrence of abnormal delivery in primipara,and can be used for prenatal evaluation.

关 键 词:初产妇 试产结局 危险因素 预测模型 

分 类 号:R714[医药卫生—妇产科学]

 

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