Development and Validation of Predictive Models for Vaginal Birth After Cesarean Delivery in China.
Development and Validation of Predictive Models for Vaginal Birth After Cesarean Delivery in China.
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中国剖腹产后阴道分娩预测模型的开发和验证
DOI：
10.12659/msm.927681
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发表时间：
2020-12-03
期刊：
影响因子：
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通讯作者：
Chen D
中科院分区：
文献类型：
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作者：
Bi S;Zhang L;Chen J;Huang L;Zeng S;Jia J;Wen S;Cao Y;Wang S;Xu X;Ling F;Zhao X;Zhao Y;Zhu Q;Qi H;Zhang L;Li H;Du L;Wang Z;Chen D
在中国，剖宫产率正在上升，剖宫产后阴道分娩（VBAC）处于早期阶段。目前尚无有效的筛选工具来预测VBAC在中国的成功率。本研究的目的是确定预测VBAC成功可能性的变量，以创建预测模型。这项多中心、回顾性研究纳入了2017年1月至2017年12月在中国7个省的11家公立三级医院进行的1013例≥28孕周的单胎妊娠和1例既往低横径剖宫产的女性。两个多变量逻辑回归模型：（1）在第一个三个月访问和（2）在产前入院。使用受试者工作特征曲线下面积（AUC）评价模型，并使用k倍交叉验证进行内部验证。对分娩前模型进行校准，并创建图形诺模图和临床影响曲线。共有87.3%（884/1013）的妇女成功地进行了VBAC，12.7%（129/1013）的妇女在试产失败后进行了计划外剖宫产。孕早期模型的AUC为0.661（95%置信区间[CI]：0.61-0.712），在产前模型中增加至0.758（95% CI：0.715-0.801）。分娩前模型显示出良好的内部效度，AUC为0.743（95%CI：0.694-0.785），并且校准良好。VBAC为妇女提供了体验阴道分娩的机会。使用产前模型预测成功的VBAC是可行的，并且可能有助于选择分娩方式并有助于降低剖腹产率。
The rate of delivery by cesarean section is rising in China, where vaginal birth after cesarean (VBAC) is in its early stages. There are no validated screening tools to predict VBAC success in China. The objective of this study was to identify the variables predicting the likelihood of successful VBAC to create a predictive model. This multicenter, retrospective study included 1013 women at ≥28 gestational weeks with a vertex singleton gestation and 1 prior low-transverse cesarean from January 2017 to December 2017 in 11 public tertiary hospitals within 7 provinces of China. Two multivariable logistic regression models were developed: (1) at a first-trimester visit and (2) at the pre-labor admission to hospital. The models were evaluated with the area under the receiver operating characteristic curve (AUC) and internally validated using k-fold cross-validation. The pre-labor model was calibrated and a graphic nomogram and clinical impact curve were created. A total of 87.3% (884/1013) of women had successful VBAC, and 12.7% (129/1013) underwent unplanned cesarean delivery after a failed trial of labor. The AUC of the first-trimester model was 0.661 (95% confidence interval [CI]: 0.61–0.712), which increased to 0.758 (95% CI: 0.715–0.801) in the pre-labor model. The pre-labor model showed good internal validity, with AUC 0.743 (95% CI: 0.694–0.785), and was well calibrated. VBAC provides women the chance to experience a vaginal delivery. Using a pre-labor model to predict successful VBAC is feasible and may help choose mode of birth and contribute to a reduction in cesarean delivery rate.