Tessmer-Tuck Jennifer A, El-Nashar Sherif A, Racek Adrianne R, Lohse Christine M, Famuyide Abimbola O, Wick Myra J
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn., USA.
Gynecol Obstet Invest. 2014;77(2):121-6. doi: 10.1159/000357757. Epub 2014 Feb 11.
To develop a model to predict vaginal birth after cesarean (VBAC) in our population and to compare the accuracy of this model to the accuracy of a previously published widely used model.
Women attempting trial of labor after cesarean delivery (TOLAC) at our institution from January 1, 2000 through May 30, 2010 were evaluated for inclusion. Demographic and clinical data were collected. Associations of these characteristics with VBAC were evaluated with univariate and multivariate logistic regression. We critically compared the accuracy of the resulting model to a previously published widely utilized model for predicting VBAC.
A total of 2,635 deliveries with at least 1 prior cesarean delivery were identified. TOLAC was attempted in 599 (22.7%) and resulted in 456 VBACs (76.0%) and 143 repeat cesareans (24.0%). VBAC success was independently associated with age <30 years, a body mass index <30, prior vaginal delivery, prior VBAC, and absence of a recurrent indication for cesarean. This model provided a range of successful probability of VBAC (38-98%) with an area under the receiver operating characteristic curve of 0.723.
This study provides an accurate and simple model that can be utilized to guide decisions related to TOLAC.
建立一个模型来预测我院人群中的剖宫产术后阴道分娩（VBAC），并将该模型的准确性与之前发表的广泛使用的模型的准确性进行比较。
对2000年1月1日至2010年5月30日在我院尝试剖宫产术后阴道试产（TOLAC）的妇女进行纳入评估。收集人口统计学和临床数据。通过单因素和多因素逻辑回归评估这些特征与VBAC的相关性。我们严格比较了所得模型与之前发表的广泛使用的预测VBAC模型的准确性。
共确定了2635例至少有1次既往剖宫产史的分娩。599例（22.7%）尝试了TOLAC，其中456例成功阴道分娩（76.0%），143例再次剖宫产（24.0%）。VBAC成功与年龄<30岁、体重指数<30、既往阴道分娩、既往VBAC以及无再次剖宫产指征独立相关。该模型提供了VBAC成功概率范围（38 - 98%），受试者工作特征曲线下面积为0.723。
本研究提供了一个准确且简单可用于指导与TOLAC相关决策的模型。
