Flamm B L, Geiger A M
Department of Obstetrics and Gynecology, Kaiser Permanente Medical Centers, Southern California Region, Riverside, USA.
Obstet Gynecol. 1997 Dec;90(6):907-10. doi: 10.1016/s0029-7844(97)00531-0.
To develop a scoring system to predict the likelihood of vaginal birth in patients undergoing a trial of labor after previous cesarean delivery using factors known at the time of hospital admission.
Trial of labor was attempted in 5022 patients who were assigned randomly to score derivation and score testing groups. Multivariate logistic regression modeling was used in the score derivation group to develop a predictive scoring system for vaginal birth. The scoring system was then applied to the testing group to evaluate its predictive ability.
Five variables significantly affected the mode of birth and were incorporated into a weighted scoring system. Rates of successful vaginal birth after cesarean ranged from 49% in patients scoring 0-2 to 95% in patients scoring 8-10. Increasing score was associated linearly with increasing probability of vaginal birth after cesarean.
Increasing scores correlate with increasing probability of vaginal birth after cesarean. The admission vaginal birth after cesarean scoring system may be useful in counseling patients regarding the option of vaginal birth or repeat cesarean delivery. This information could be particularly valuable for the patient who opts for trial of labor but has second thoughts about her mode of birth when labor begins.
利用入院时已知的因素，开发一种评分系统，以预测既往剖宫产术后进行引产的患者阴道分娩的可能性。
对5022例患者进行引产尝试，这些患者被随机分配到评分推导组和评分测试组。在评分推导组中使用多因素逻辑回归模型来开发阴道分娩的预测评分系统。然后将该评分系统应用于测试组以评估其预测能力。
五个变量显著影响分娩方式，并被纳入加权评分系统。剖宫产术后成功阴道分娩的比例在得分为0 - 2分的患者中为49%，在得分为8 - 10分的患者中为95%。评分增加与剖宫产术后阴道分娩概率增加呈线性相关。
评分增加与剖宫产术后阴道分娩概率增加相关。入院剖宫产术后阴道分娩评分系统可能有助于为患者提供关于阴道分娩或再次剖宫产选择的咨询。对于选择引产但在分娩开始时对分娩方式有疑虑的患者，此信息可能特别有价值。
