Nanjing Maternity and Child Health Care Institute, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, 210004, China.
State key Laboratory of Reproductive Medicine, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, 210004, China.
Sci Rep. 2018 Feb 15;8(1):3084. doi: 10.1038/s41598-018-21488-6.
There is an urgent need in China to better predict vaginal birth after cesarean (VBAC) to face the challenge of the second child policy. We aimed to validate a widely used VBAC prediction model (Grobman's model) and a modified version of this model in a Chinese population. In this retrospective cohort study, 444 women with one cesarean delivery and at least one subsequent attempt for a trial of labor in Nanjing, China were included. The considered potential VBAC predictors included Grobman's background variables and five new variables. Overall, a total of 370 women had VBAC, with a success rate of 83.3%. The new background variables "maternal height" and "estimated fetal weight" were considered as two additional predictors for VBAC. The AUC of Grobman's model was 0.831 (95%CI = 0.775-0.886) while the AUC of our modified model with two new variables added was 0.857 (sensitivity = 72.2%, specificity = 83.8%). However, the difference between the AUC of the two models was not significant (Z = -1.69, P = 0.091). We confirmed that Grobman's model was accepted in the Chinese population. A modified model that is supplemented with maternal height and estimated fetal weight needs to be further studied in the Chinese population.
在中国，迫切需要更好地预测剖宫产术后阴道分娩（VBAC），以应对二孩政策带来的挑战。我们旨在验证一种广泛使用的 VBAC 预测模型（Grobman 模型）及其在中国人群中的改良版本。在这项回顾性队列研究中，纳入了在中国南京进行过一次剖宫产术且至少有一次尝试试产的 444 名妇女。考虑的潜在 VBAC 预测因素包括 Grobman 的背景变量和五个新变量。总的来说，共有 370 名妇女实现 VBAC，成功率为 83.3%。新的背景变量“产妇身高”和“估计胎儿体重”被认为是 VBAC 的另外两个预测因素。Grobman 模型的 AUC 为 0.831（95%CI=0.775-0.886），而加入两个新变量的改良模型的 AUC 为 0.857（灵敏度=72.2%，特异性=83.8%）。然而，两个模型的 AUC 差异无统计学意义（Z=-1.69，P=0.091）。我们证实了 Grobman 模型在中国人群中是可以接受的。需要进一步研究补充产妇身高和估计胎儿体重的改良模型在中国人群中的适用性。
