Papoutsis Dimitrios, Antonakou Angeliki, Gornall Adam, Tzavara Chara, Mohajer Michelle
Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals, NHS Trust, Apley Castle, Grainger Drive, Telford, TF16TF, UK.
Department of Midwifery, Midwifery School, 'Alexander' Technological Educational Institute of Thessaloniki, Thessaloniki, Greece.
Arch Gynecol Obstet. 2017 Jan;295(1):59-66. doi: 10.1007/s00404-016-4209-4. Epub 2016 Sep 27.
To develop a risk-assessment model for the prediction of emergency cesarean section (CS) in women having induction of labor (IOL).
This was an observational cohort study of women with IOL for any indication between 2007 and 2013. Women induced for stillbirths and with multiple pregnancies were excluded. The primary objective was to identify risk factors associated with CS delivery and to construct a risk-prediction tool.
6169 women were identified with mean age of 28.9 years. Primiparity involved 47.1 %, CS rate was 13.3 % and post-date pregnancies were 32.4 %. Risk factors for CS were: age >30 years, BMI >25 kg/m, primiparity, black-ethnicity, non post-date pregnancy, meconium-stained liquor, epidural analgesia, and male fetal gender. Each factor was assigned a score and with increasing scores the CS rate increased. The CS rate was 5.4 % for a score <11, while for a score ≥11 it increased to 25.0 %. The model had a sensitivity, specificity, negative predictive value and positive predictive value of 75.8, 65.1, 93.8 and 25.0 %, respectively.
We have constructed a risk-prediction tool for CS delivery in women with IOL. The risk-assessment tool for the prediction of emergency CS in induced labor has a high negative-predictive value and can provide reassurance to presumed low-risk women.
建立一种风险评估模型，用于预测引产妇女的急诊剖宫产情况。
这是一项针对2007年至2013年间因任何指征引产的妇女的观察性队列研究。排除因死产引产和多胎妊娠的妇女。主要目的是确定与剖宫产分娩相关的风险因素，并构建一个风险预测工具。
共纳入6169名妇女，平均年龄28.9岁。初产妇占47.1%，剖宫产率为13.3%，过期妊娠率为32.4%。剖宫产的风险因素包括：年龄>30岁、体重指数>25kg/m²、初产妇、黑人种族、非过期妊娠、羊水粪染、硬膜外镇痛和男性胎儿性别。每个因素都被赋予一个分数，分数越高，剖宫产率越高。分数<11时，剖宫产率为5.4%，而分数≥11时，剖宫产率增至25.0%。该模型的敏感性、特异性、阴性预测值和阳性预测值分别为75.8%、65.1%、93.8%和25.0%。
我们构建了一种用于引产妇女剖宫产分娩的风险预测工具。该引产急诊剖宫产预测风险评估工具具有较高的阴性预测值，可为假定为低风险的妇女提供安心保障。
