Zhou Ping, Chen Han, Zhang Yang, Yao Min
Department of Gynecology, Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
Department of Ultrasound, Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
Front Surg. 2023 Jan 6;9:1048866. doi: 10.3389/fsurg.2022.1048866. eCollection 2022.
Accurate identification of nulliparous women with failed spontaneous vaginal delivery (SVD) is crucial to minimize the hazards associated with obstetrical intervention (OI). While abnormal labor progression can be identified with intrapartum ultrasonography, labor-related complications may be unavoidable due to the limited time window left to the obstetrician. Antepartum ultrasound enables sufficient obstetric planning. However, there is typically a longer gap between ultrasound assessment and delivery that often lowers the prediction accuracy compared to intrapartum ultrasonography.
In this study, antepartum ultrasound assessment was included to each fetal ultrasound examination after 36 weeks of gestation until the onset of labor. We aim to establish a nomogram to predict the likelihood of failed SVD in nulliparous women using the last antepartum ultrasound findings before labor beginning.
Of the 2,143 nulliparous women recruited, 1,373 were included in a training cohort and 770 in a validation cohort, based on their delivery date. Maternal and perinatal characteristics, as well as perinatal ultrasound parameters were collected. In the training cohort, the screened correlates of SVD failure were used to develop a nomogram for determining whether a nulliparous woman would experience SVD failure. This model was validated in both training and validation cohorts.
SVD failure affected 217 nulliparous women (10.13%). In the training cohort, SVD failure was independently associated with BMI [odds ratio (OR) = 1.636], FHC (OR = 1.194), CL (OR = 1.398), and PCA (OR = 0.824) (all < 0.05). They constituted a nomogram to estimate the individual risk of SVD failure. The model obtained clinical net benefits in both the training and validation cohorts and was validated to present strong discrimination and calibration.
The developed nomogram based on the last antepartum ultrasound findings may be helpful in avoiding OI and its related complications by assessing the likelihood of a failed SVD in nulliparous women.
准确识别自然阴道分娩（SVD）失败的初产妇对于将与产科干预（OI）相关的危害降至最低至关重要。虽然产时超声检查可以识别产程异常，但由于留给产科医生的时间窗口有限，与分娩相关的并发症可能不可避免。产前超声有助于进行充分的产科规划。然而，与产时超声检查相比，超声评估与分娩之间的间隔通常更长，这往往会降低预测准确性。
在本研究中，在妊娠36周后直至分娩开始的每次胎儿超声检查中均纳入产前超声评估。我们旨在建立一个列线图，使用分娩开始前的最后一次产前超声检查结果来预测初产妇SVD失败的可能性。
在招募的2143名初产妇中，根据她们的分娩日期，1373名被纳入训练队列，770名被纳入验证队列。收集产妇和围产期特征以及围产期超声参数。在训练队列中，筛选出的SVD失败相关因素用于建立一个列线图，以确定初产妇是否会发生SVD失败。该模型在训练队列和验证队列中均进行了验证。
217名初产妇（10.13%）发生了SVD失败。在训练队列中，SVD失败与体重指数[比值比（OR）=1.636]、胎儿头围（OR=1.194）、宫颈长度（OR=1.398）和骨盆前后径（OR=0.824）独立相关（均P<0.05）。它们构成了一个列线图来估计SVD失败的个体风险。该模型在训练队列和验证队列中均获得了临床净效益，并经验证具有很强的区分度和校准度。
基于最后一次产前超声检查结果开发的列线图，通过评估初产妇SVD失败的可能性，可能有助于避免OI及其相关并发症。
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