Abdel-Aleem Hany, Darwish Atef, Abdelaleem Ahmad A, Mansur Manal
Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut, Egypt.
Int J Gynaecol Obstet. 2017 Apr;137(1):40-44. doi: 10.1002/ijgo.12092. Epub 2017 Jan 31.
To assess use of the C-Model in a tertiary hospital setting in terms of its validity and utility for optimizing the cesarean delivery (CD) rate.
A prospective observational study included women admitted for delivery at a university teaching hospital in Assiut, Egypt, in 2015. The women were asked about the demographic and obstetric information needed to calculate the probability of CD using the WHO C-Model. A receiver operating characteristic (ROC) curve comparing the predicted and observed CD rates was constructed. In addition, the mean predicted CD rates were compared with the mean observed CD rates in the 10 groups of the Robson classification.
In total, 1000 women were recruited; 38.6% had a previous CD and 13.5% had complications during the current pregnancy. The final mode of delivery was vaginal delivery in 38.7% and CD in 61.3%; the predicted CD rate for this cohort was 45.0%. The area under the ROC curve was 0.928 (95% confidence interval 0.912-0.945). Comparison of the predicted and observed CD rates in the 10 Robson groups showed an overuse of CD ranging from 2% to 50%.
The WHO C-Model is valid and can be used in hospital settings to optimize CD rates.
在一家三级医院环境中评估C模型在优化剖宫产率方面的有效性和实用性。
一项前瞻性观察性研究纳入了2015年在埃及阿斯尤特一所大学教学医院住院分娩的女性。向这些女性询问了使用世界卫生组织C模型计算剖宫产概率所需的人口统计学和产科信息。构建了一条比较预测剖宫产率和观察到的剖宫产率的受试者工作特征（ROC）曲线。此外，还比较了Robson分类10组中的平均预测剖宫产率和平均观察到的剖宫产率。
总共招募了1000名女性；38.6%既往有剖宫产史，13.5%在本次妊娠期间有并发症。最终分娩方式为阴道分娩的占38.7%，剖宫产的占61.3%；该队列的预测剖宫产率为45.0%。ROC曲线下面积为0.928（95%置信区间0.912 - 0.945）。10个Robson组中预测剖宫产率与观察到的剖宫产率的比较显示，剖宫产过度使用比例在2%至50%之间。
世界卫生组织C模型是有效的，可用于医院环境中优化剖宫产率。
