BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Fetal i+D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain,
BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Fetal i+D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain.
Fetal Diagn Ther. 2019;46(2):88-96. doi: 10.1159/000493343. Epub 2018 Oct 5.
To develop a model combining clinical and sonographic features to predict the risk of cesarean delivery after the induction of labor (IOL).
We designed a prospective observational study involving women admitted for IOL. The main outcome was defined as cesarean delivery due to failed IOL or arrest of labor. Several clinical and ultrasonographic variables were collected. Seventy percent of the sample was used to build the predictive model, using stepwise logistic regression, while the remaining sample was used for validation. The final model was estimated and calibrated using all participants.
We analyzed 477 pregnancies. The main outcome occurred in 102/477 (21.4%) women. The final model included previous vaginal delivery (odds ratio [OR] 0.088; 95% confidence interval [CI] 0.04-0.21), height (OR 0.904; 95% CI 0.87-0.94), body mass index before delivery (OR 1.084; 95% CI 1.02-1.15), ultrasonographic estimated fetal weight (OR 3.965; 95% CI 2.18-7.22), and ultrasonographic cervical length (OR 1.065; 95% CI 1.04-1.09) as predictors. Area under the receiver operating characteristics curve was 0.826 (95% CI 0.78-0.87). For a 5% false-positive rate, the sensitivity, specificity, and positive and negative likelihood ratios were 44.1%, 94.9%, 8.7, and 0.59, respectively.
Our model combining clinical and ultrasonographic features might offer individualized counseling regarding risk of cesarean delivery to women who are candidates for IOL.
建立一个结合临床和超声特征的模型，以预测引产（IOL）后行剖宫产的风险。
我们设计了一项前瞻性观察性研究，纳入因 IOL 入院的女性。主要结局定义为因 IOL 失败或产程停滞而行剖宫产。收集了几种临床和超声变量。样本的 70%用于建立预测模型，使用逐步逻辑回归，而其余样本用于验证。使用所有参与者对最终模型进行估计和校准。
我们分析了 477 例妊娠。主要结局发生在 102/477（21.4%）例女性中。最终模型包括既往阴道分娩（比值比 [OR] 0.088；95%置信区间 [CI] 0.04-0.21）、身高（OR 0.904；95% CI 0.87-0.94）、分娩前体重指数（OR 1.084；95% CI 1.02-1.15）、超声估计胎儿体重（OR 3.965；95% CI 2.18-7.22）和超声宫颈长度（OR 1.065；95% CI 1.04-1.09）。受试者工作特征曲线下面积为 0.826（95% CI 0.78-0.87）。对于假阳性率为 5%，灵敏度、特异度、阳性和阴性似然比分别为 44.1%、94.9%、8.7 和 0.59。
我们的模型结合了临床和超声特征，可为行 IOL 的候选者提供关于剖宫产风险的个体化咨询。
