足月初产妇分娩方式评估模型的建立与效用评价  

Establishment and Effectiveness Evaluation of the Evaluation Model in Predicting Delivery Mode of Full-term Primipara

作　　者：周朝芬 袁里朝 夏明珠 郑秀娟[1,2] 楼建义 蒋盼[1,2] 丁明星 ZHOU Chaofen;YUAN Lichao;XIA Mingzhu;ZHENG Xiujuan;LOU Jianyi;JIANG Pan;DING Mingxing(Department of Obstetrics,Jinhua Central Hospital,Jinhua 321000,Zhejiang,China;Department of Obstetrics,Jinhua Maternal and Child Health Hospital,Jinhua 321000,Zhejiang,China;School of Medicine,Jinhua University of Vocational Technology,Jinhua 321007,Zhejiang,China)

机构地区：[1]金华市中心医院产科,浙江金华321000 [2]金华市妇幼保健院产科,浙江金华321000 [3]金华职业技术学院医学院,浙江金华321007

出　　处：《医学信息》2025年第3期126-129,共4页Journal of Medical Information

基　　金：金华市科技计划项目(编号:2022-3-131)。

摘　　要：目的建立足月初产妇分娩方式评估模型并评价其效用。方法回顾性分析2020年9月-2021年7月我院收治的足月分娩初产妇615例的临床资料,分析分娩方式的独立危险因素,建立列线图评估模型,并对模型的预测性及准确度进行验证。结果共纳入615例患者,阴道分娩成功组493例,阴道分娩失败组122例。阴道分娩失败组的孕前体重指数(BMI)、孕期增重、孕周、催引产数及新生儿体重均高于阴道分娩成功组,差异有统计学意义(P<0.05)。Logistic回归因素分析显示,分娩初产妇年龄≥28岁、孕周>40周、催引产、新生儿体重>3500 g是阴道分娩失败中转剖宫产的独立危险因素(P<0.05)。基于上述危险因素建立列线图评估模型,验证结果显示ROC曲线下面积为0.717,列线图校准曲线平均绝对误差为0.016,拟合度良好。结论基于初产妇年龄、孕周、催引产及新生儿体重等危险因素建立的列线图评估模型有良好的区分度与一致性,可为初产妇临床分娩方式的评估提供参考。Objective To establish a delivery mode evaluation model for full-term primiparas and evaluate its effectiveness.Methods The clinical data of 615 primiparas with full-term delivery admitted to our hospital from September 2020 to July 2021 were retrospectively analyzed.The independent risk factors of delivery mode were analyzed,a nomogram evaluation model was established,and the predictability and accuracy of the model were verified.Results A total of 615 patients were included,493 patients in the successful vaginal delivery group and 122 patients in the failed vaginal delivery group.The pre-pregnancy body mass index(BMI),weight gain during pregnancy,gestational age,number of induced labor and neonatal weight in the failed vaginal delivery group were higher than those in the successful vaginal delivery group,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that age≥28 years old,gestational age>40 weeks,induction of labor,neonatal weight>3500 g were independent risk factors for conversion to cesarean section after vaginal delivery failure(P<0.05).Based on the above risk factors,a nomogram evaluation model was established.The verification results showed that the area under the ROC curve was 0.717,the average absolute error of the nomogram calibration curve was 0.016,and the fitting degree was good.Conclusion The nomogram evaluation model based on risk factors such as age,gestational age,induced labor and neonatal weight of primipara has good discrimination and consistency,which can provide reference for the evaluation of clinical delivery mode of primipara.

关 键 词：初产妇 分娩方式 列线图 预测 

分 类 号：R714.4[医药卫生—妇产科学]