Department of Gynecology and Obstetrics, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Daoshan Road 18, Gulou District, Fujian, 350000, Fuzhou, China.
BMC Pregnancy Childbirth. 2020 Oct 20;20(1):639. doi: 10.1186/s12884-020-03231-0.
Evidence-based medicine has shown that successful vaginal birth after cesarean (VBAC) is associated with fewer complications than an elective repeat cesarean. Although spontaneous vaginal births and reductions in cesarean delivery (CD) rates have been advocated, the risk factors for VBAC complications remain unclear and failed trials of labor (TOL) can lead to adverse pregnancy outcomes.
To construct an antepartum predictive scoring model for VBAC. Retrospective analysis of charts from 1062 women who underwent TOL at no less than 28 gestational weeks with vertex singletons and no more than one prior CD.
We constructed our scoring model based on the following variables: maternal age, previous vaginal delivery, interdelivery interval (time between prior cesarean and the following delivery), presence of prior cesarean TOL, dystocia as prior CD indication, intertuberous diameter, maternal predelivery body mass index, gestational age at delivery, estimated fetal weight, and hypertensive disorders. Previous vaginal delivery was the most influential variable. The nomogram showed an area under the curve of 77.7% (95% confidence interval, 73.8-81.5%; sensitivity, 78%; specificity, 70%; cut-off, 13 points). The Kappa value to judge the consistency of the results between the predictive model and the actual results was 0.71(95% confidence interval 0.65-0.77) indicating strong consistency. We used the cut-off to divide the VBAC women into two groups according to the success of the TOL. The maternal and neonatal outcomes such as labor time, number of deliveries by midwives, postpartum hemorrhage, uterine rupture, neonatal asphyxia, puerperal infection were significantly different between the two groups.
Our predictive scoring model incorporates easily ascertainable variables and can be used to personalize antepartum counselling for successful TOLs after cesareans.
循证医学表明，与选择性再次剖宫产相比，成功的剖宫产后阴道分娩（VBAC）与更少的并发症相关。尽管提倡自然阴道分娩和降低剖宫产率，但 VBAC 并发症的风险因素仍不清楚，并且试产失败可能导致不良妊娠结局。
构建 VBAC 的产前预测评分模型。对至少 28 孕周行 TOL 的 1062 名单胎头位且既往仅行 1 次剖宫产的女性的图表进行回顾性分析。
我们基于以下变量构建了评分模型：产妇年龄、既往阴道分娩、产次间隔（既往剖宫产与随后分娩之间的时间）、既往剖宫产 TOL 史、既往剖宫产指征为难产、横径、产妇分娩前 BMI、分娩时的孕龄、估计胎儿体重和高血压疾病。既往阴道分娩是最具影响力的变量。列线图显示曲线下面积为 77.7%（95%置信区间，73.8-81.5%；敏感性，78%；特异性，70%；截断值，13 分）。预测模型与实际结果之间的一致性判断的 Kappa 值为 0.71（95%置信区间 0.65-0.77），表明一致性强。我们使用截断值根据 TOL 的成功与否将 VBAC 女性分为两组。两组产妇的产程时间、助产士分娩次数、产后出血、子宫破裂、新生儿窒息、产褥感染等母婴结局差异有统计学意义。
我们的预测评分模型纳入了易于确定的变量，可用于个性化剖宫产术后成功 TOL 的产前咨询。
