足月臀位外倒转术成功预测模型的建立与验证  

Development and validation of a predictive model for successful external cephalic version in breech presentation at term

作　　者：吴英 周建新[1] 姜海利[1] Wu Ying;Zhou Jianxin;Jiang Haili(Department of Obstetrics,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing100026)

机构地区：[1]首都医科大学附属北京妇产医院产科,北京100026

出　　处：《现代妇产科进展》2024年第9期670-674,共5页Progress in Obstetrics and Gynecology

摘　　要：目的:建立单胎足月臀位外倒转术成功的预测模型并进行内部验证。方法:回顾分析2015年1月至2021年9月在首都医科大学附属北京妇产医院行臀位外倒转术的485例单胎臀位孕妇的临床资料,按手术结局分为成功组和失败组。采用logistic回归模型进行多因素分析,筛选出外倒术成功的影响因素作为预测因子建立预测模型,应用R软件构建预测模型的列线图。绘制受试者工作特征(ROC)曲线对模型预测性能进行评估,并运用Bootstrap法进行内部验证。结果:经产、宫缩抑制剂使用、胎儿体重<2960g、羊水指数≥11.3cm、非前壁胎盘、脐绕颈<2周是外倒转术成功的独立有利因素,纳入上述6个因素作为预测因子,建立外倒转术成功的预测模型及列线图。该预测模型的ROC曲线下面积为0.74(95%CI为0.70~0.79),此时灵敏度为71.43%,特异度为67.38%。模型的内部验证结果提示其预测曲线与临床实际曲线一致性良好。结论:基于上述预测因子建立的足月臀位外倒转术成功的预测模型具有较好的预测效能,可为临床医生进行临床咨询和选择外倒转术的适宜人群提供参考。Objective:To develop and internally validate a predictive model for the success external cephalic version(ECV)in singleton term breech pregnancies.Methods:This is a retrospective single-center study among 485 singleton pregnant women who underwent ECV at Beijing Obstetrics and Gynecology Hospital,Capital Medical University from January 2015 to September 2021.They were divided into a successful group and a failed group according to the surgical outcome.Multivariate analysis was performed using the logistic regression model to screen out the influencing factors of successful ECV as predictors to establish a predictive model.The nomogram of the predictive model was constructed using R software.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive performance of the model,and the Bootstrap method was used for internal validation.Results:Multiparity the use of tocolytic agents,fetal weight<2960g,amniotic fluid index≥11.3cm,non-anterior placenta,and nuchal cord<2 weeks were independent favorable factors for the success of ECV.The above six factors were included as predictors to establish a predictive model and nomogram for the success of ECV.The area under the ROC curve of this predictive model was 0.74(95%CI:0.70~0.79),with a sensitivity of 71.43%and a specificity of 67.38%at this time.The internal validation results of the model suggested that its predictive curve was consistent with the clinical actual curve observed.Conclusion:The predictive model for the successful ECV in term breech pregnancies was developed based on the above predictors.It has good predictive efficacy and can provide a reference for obstetricians in clinical consultation and selection of appropriate populations for ECV.

关 键 词：臀位 外倒转术 成功 预测模型 内部验证 

分 类 号：R714[医药卫生—妇产科学]