Simple, validated vaginal birth after cesarean delivery prediction model for use at the time of admission.
Simple, validated vaginal birth after cesarean delivery prediction model for use at the time of admission.
复制标题
剖宫产预测模型在入院时使用后简单，经过验证的阴道出生。
DOI：
10.1097/aog.0b013e31829f8ced
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发表时间：
2013-09
影响因子：
7.2
通讯作者：
Esplin S
中科院分区：
文献类型：
--
作者：
Metz TD;Stoddard GJ;Henry E;Jackson M;Holmgren C;Esplin S
创建一个简单的工具，使用入院时可用的变量来预测初次剖宫产后怀孕期间剖宫产后试产 (TOLAC) 成功的可能性。对 14 家地区医院 8 年来所有分娩的数据进行了审查。包括一名剖腹产和一名后续分娩的妇女。使用多变量逻辑回归确定与成功 VBAC 相关的变量。为这些特征分配分数，并根据回归模型中的系数进行加权，以计算整数 VBAC 分数。 VBAC 评分与 TOLAC 成功率相关，并使用逻辑回归模型在独立队列中进行了外部验证。共有 5,445 名女性符合纳入标准。在这些女性中，有 1,170 名 (21.5%) 接受了 TOLAC。在接受试产的女性中，938 名 (80%) 的 VBAC 成功。 AVBAC 评分是根据入院时的 Bishop 评分（宫颈检查）生成的，并根据阴道分娩史、年龄小于 35 岁、无复发指征以及体重指数小于 30 进行加分。VBAC 评分低于 10 的女性 TOLAC 成功的可能性低于 50%。 VBAC 分数超过 16 分的女性 TOLAC 成功率超过 85%。该模型在独立队列中表现良好，曲线下面积为 0.80（95% 置信区间 0.76-0.84）。入院时 TOLAC 成功的预测很大程度上取决于最初的宫颈检查。当为考虑 TOLAC 的女性提供咨询时，可以使用这个简单的 VBAC 评分。
To create a simple tool for predicting the likelihood of successful trial of labor after cesarean delivery (TOLAC) during the pregnancy after a primary cesarean delivery using variables available at the time of admission. Data for all deliveries at 14 regional hospitals over an 8-year period were reviewed. Women with one cesarean delivery and one subsequent delivery were included. Variables associated with successful VBAC were identified using multivariable logistic regression. Points were assigned to these characteristics, with weighting based on the coefficients in the regression model to calculate an integer VBAC score. The VBAC score was correlated with TOLAC success rate and was externally validated in an independent cohort using a logistic regression model. A total of 5,445 women met inclusion criteria. Of those women, 1,170 (21.5%) underwent TOLAC. Of the women who underwent trial of labor, 938 (80%) had a successful VBAC. AVBAC score was generated based on the Bishop score (cervical examination) at the time of admission, with points added for history of vaginal birth, age younger than 35 years, absence of recurrent indication, and body mass index less than 30. Women with a VBAC score less than 10 had a likelihood of TOLAC success less than 50%. Women with a VBAC score more than 16 had a TOLAC success rate more than 85%. The model performed well in an independent cohort with an area under the curve of 0.80 (95% confidence interval 0.76–0.84). Prediction of TOLAC success at the time of admission is highly dependent on the initial cervical examination. This simple VBAC score can be utilized when counseling women considering TOLAC.