剖宫产术后再次妊娠阴道试产的列线图预测模型构建及应用  

Construction and application of nomogram prediction model for trial of labor after cesarean

作　　者：钱云凤 程国青 邓雪梅 位丹丹 Qian Yunfeng;Cheng Guoqing;Deng Xuemei;Wei Dandan(Department of Gynaecology,The Third Affiliated Hospital of Naval Medical University,Shanghai 201800,China)

机构地区：[1]海军军医大学第三附属医院妇科,上海201800 [2]海军军医大学第一附属医院妇产科

出　　处：《海军医学杂志》2025年第1期63-67,共5页Journal of Navy Medicine

摘　　要：目的 探究剖宫产术后再次妊娠阴道试产(TOLAC)失败的影响因素,构建TOLAC列线图预测模型并验证该模型的预测效果。方法 回顾性分析海军军医大学第一附属医院2019-2022年收治的273例剖宫产术后TOLAC产妇的临床资料,采用logistic回归分析TOLAC失败的影响因素,并建立列线图模型用于个体化风险评估。结合决策曲线与临床影响曲线评估TOLAC失败风险的最佳阈值。结果 阴道试产成功组和阴道试产失败组的年龄、孕周、分娩前体重指数(BMI)、距离上次剖宫产时间、宫颈Bishop评分以及分娩次数的差异有统计学意义。结合决策曲线与临床影响曲线提示最佳干预阈值为0.72,即模型预测TOLAC失败风险达72%以上需要停止阴道试产。结论 年龄、孕周、分娩前BMI、距离上次剖宫产时间、宫颈Bishop评分以及分娩次数是TOLAC失败的影响因素,以此为基础建立的列线图模型可作为产妇个体化风险评估的指标。Objective To explore the influencing factors of the failure in trial of labor after cesarean(TOLAC),construct and verify a prediction model for the risk of TOLAC.Methods The clinical data of 273 pregnant women who underwent TOLAC in The First Affiliated Hospital of Naval Medical University from 2019 to 2022 were retrospectively analyzed.Logistic regression was used to analyze influencing factors of the failure in TOLAC,and a nomogram model was established for individualized risk assessment.The best threshold of failure risk of TOLAC was evaluated by the decision-making curve and clinical influence curve.Results There were statistically significant differences in the age,gestational week,body mass index(BMI)before delivery,time to the last cesarean,cervical Bishop score and delivery times between the successful trial delivery group and the failed trial delivery group.The best intervention threshold was 0.72,that is,vaginal trial delivery should to be stopped when the risk of TOLAC failure was more than 72%as evaluated by the prediction model.Conclusion Age,gestational week,BMI before delivery,time to the last cesarean,Bishop score of cervix and delivery times are influencing factors for TOLAC failure.The prediction model based on these factors can provide a quantifiable TOLAC risk for pregnant women.

关 键 词：剖宫产术后再次妊娠阴道试产 列线图 决策曲线 

分 类 号：R714[医药卫生—妇产科学]