巴塞罗那大学医院剖宫产术后阴道分娩成功预测模型的验证
Validation of the prediction model for success of vaginal birth after cesarean delivery at the university hospital in Barcelona.
作者信息
Baranov Anton, Gratacós Eduard, Vikhareva Olga, Figueras Francesc
机构信息
a Department of Obstetrics and Gynecology , Skåne University Hospital Malmö, Lund University , Sweden.
b BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER) , Barcelona , Spain.
出版信息
J Matern Fetal Neonatal Med. 2017 Dec;30(24):2998-3003. doi: 10.1080/14767058.2016.1271407. Epub 2017 Jan 4.
OBJECTIVE
To validate the prediction model for successful vaginal birth after cesarean delivery (VBAC) based on variables easily obtainable at the first antenatal visit, in a Spanish population.
METHODS
Retrospective observational study. Women with a single live fetus in cephalic presentation with one previous low-transverse CD who underwent trial of labor after cesarean delivery (TOLAC) at ≥37 gestational weeks between January 2011 and December 2015 were identified in the hospital's information system. Their antenatal medical records and delivery summary reports were reviewed and individual probabilities of successful VBAC were calculated, according to a previously published model. These probabilities were categorized into deciles. For calibration, each decile of predicted probabilities was compared to the observed rates. To assess the accuracy of the prediction model, receiver operating characteristic curve was constructed and the area under the curve (AUC) was calculated.
RESULTS
In total, 630 women who underwent TOLAC had all required information and were included in the study. Among them, 450 (71.4%) women had successful VBAC. The AUC was 0.70 (95% confidence interval 0.66-0.74).
CONCLUSION
Prediction ability of the validated model was in agreement with the original study.
目的
在西班牙人群中，基于首次产前检查时易于获取的变量，验证剖宫产术后成功经阴道分娩（VBAC）的预测模型。
方法
回顾性观察研究。在医院信息系统中识别出2011年1月至2015年12月期间，孕周≥37周、单活胎头先露、既往有一次低位横切口剖宫产史且接受剖宫产术后阴道试产（TOLAC）的女性。查阅她们的产前病历和分娩总结报告，并根据先前发表的模型计算成功VBAC的个体概率。这些概率被分为十分位数。为了进行校准，将预测概率的每个十分位数与观察到的发生率进行比较。为评估预测模型的准确性，构建受试者工作特征曲线并计算曲线下面积（AUC）。
结果
共有630名接受TOLAC的女性具备所有所需信息并被纳入研究。其中，450名（71.4%）女性成功VBAC。AUC为0.70（95%置信区间0.66 - 0.74）。
结论
验证模型的预测能力与原研究一致。
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