Vaginal birth after cesarean: Does accuracy of predicted success change from prenatal intake to admission?
Vaginal birth after cesarean: Does accuracy of predicted success change from prenatal intake to admission?
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DOI：
10.1016/j.ajogmf.2020.100094
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发表时间：
2020-05-01
影响因子：
6.3
通讯作者：
Gaw, Stephanie L.
中科院分区：
文献类型：
--
作者：
Ha, Thoa K.;Rao, Rashmi R.;Gaw, Stephanie L.
背景：有2种预测剖宫产后阴道分娩的列线图。第一个是基于变量，可在第一次产前访视，第二个包括变量在admission.Objective：本研究的目的是比较准确性的预测分数，计算的摄入量和入院预测诺模图在现代队列的种族和民族多样化的妇女。这是一项回顾性队列研究，分析了2007-2016年在三级医疗中心尝试分娩的至少1次剖宫产的女性的数据。参与者被分为3个成功概率组：低（65%）。主要结果是3组患者的入院预测成功评分和入院预测成功评分之间的差异。次要结局是与剖宫产后阴道分娩成功相关的特征。结果：在纳入分析的614名妇女中，444名（72.3%）剖宫产后阴道分娩成功。预测剖宫产后阴道分娩成功率范围为14.4- 96.2%。患者按摄入预测成功率分为3组：低（65%; n=457）。预测成功率的变化之间的摄入量和入院诺模图进行了比较。当纳入入院时的变量时，低和中度组的妇女的预测得分提高了约7-8%。结果，超过一半的女性（172/307; 56%）转向了更高的预测成功组。入院列线图，与摄入列线图相比，更准确地预测阴道分娩后，剖宫产成功的所有群体。入院变量分析显示，宫颈扩张>2 cm与宫颈闭合相比是剖宫产后阴道分娩成功的最强预测因素（相对危险度，1.79; 95%可信区间，1.11-2.89）。结论：入院预测诺模图比同一队列的入院诺模图更准确，显示出更高的预测成功率。由于预测分数可能会在入院时提高，因此有关试产风险和益处的额外咨询可能会在那时有所帮助。
BACKGROUND: There are 2 prediction nomograms for vaginal birth after cesarean delivery. The first is based on variables that are available at the first prenatal visit, and the second includes variables at the time of admission.OBJECTIVE: The purpose of this study was to compare the accuracy of prediction scores that are calculated by the intake and admission prediction nomograms in a modern cohort of racially and ethnically diverse women.STUDY DESIGN: This is a retrospective cohort study that analyzed the data for women with at least 1 previous cesarean delivery who attempted a trial of labor from 2007-2016 at a tertiary medical center. Participants were stratified into 3 probability-of-success groups: low (65%). The primary outcome was the difference between the intake- and admission-predicted success scores in the 3 groups. Secondary outcomes were characteristics that were associated with successful vaginal birth after cesarean delivery.RESULTS: Of the 614 women included in the analysis, 444 (72.3%) had a successful vaginal birth after cesarean delivery. Predicted vaginal birth after cesarean delivery success rate ranged from 14.4-96.2%. Patients were stratified into 3 groups by intake predicted success rates: low (65%; n=457). The change in predicted success rates was compared between the intake and admission nomograms. Women in the low and moderate groups improved their prediction score by approximately 7-8% when variables at the time of admission were included. As a result, more than one-half of these women (172/307; 56%) shifted to a higher predicted success group. The admission nomogram, as compared with the intake nomogram, more accurately predicted vaginal birth after cesarean delivery success in all groups. Analysis of admission variables showed that cervical dilation >2 cm compared with a closed cervix was the strongest predictor of successful vaginal birth after cesarean delivery (relative risk, 1.79; 95% confidence interval, 1.11-2.89).CONCLUSION: The admission prediction nomogram was more accurate and showed higher predicted success compared with the intake nomogram for the same cohort. Because prediction scores may improve at the time of admission, additional counseling on the risks and benefits of trial of labor may be helpful at that time.