Application of trial of labor after cesarean in preterm women without a history of vaginal delivery
Objective To investigate the application of trial of labor after cesarean(TOLAC)in preterm women without a history of vaginal delivery history.Methods A total of 116 pregnant women without a history of vaginal delivery who were hospitalized due to preterm labor and underwent TOLAC at our hospital between January 2018 and June 2022 were retrospectively included.Based on whether TOLAC was successful,the subjects were divided into TOLAC success group(n=89)and TOLAC failure group(n=27).The least absolute shrinkage and selection operator(LASSO)regression was used to screen variables related to TOLAC success rate,and a prediction model for TOLAC success rate was constructed.The concordance index(C-index)was used for internal validation of the prediction model.Results There were statistically significant differences between the TOLAC success group and the TOLAC failure group in terms of cervical dilation at admission,cervical effacement at admission and membrane rupture time(t=3.382,3.377 and 2.027,respectively,P＜0.05).There were statistically significant differences between the two groups in the rates of epidural analgesia at admission,Bishop score＜4,induction of labor,premature rupture of membranes and oxytocin administration(x2=3.517,8.024,14.111,6.570 and 4.038,respectively,P＜0.05).A total of 9 variables(cervical dilatation at admission,cervical effacement at admission,epidural analgesia,Bishop score＜4,induction of labor,premature rupture of membranes,membrane rupture time,oxytocin administration,and cervical dilation at delivery)were included for LASSO regression to screen predictive variables for the TOLAC success rate.A nomogram was used to display the predictive factors in the TOLAC success rate model,including cervical dilation at admission(OR=1.11,95％CI:1.04-1.19,P=0.003),induction of labor(OR=0.89,95％CI:0.79-1.00,P=0.049),oxytocin administration(OR=0.71,95％CI:0.58-0.88,P=0.002),premature rupture of membranes(OR=3.27,95％CI:2.49-4.45,P=0.001),Bishop score＜4(OR=0.33,95％CI:0.17-0.62,P=0.001)and epidural anesthesia(OR=2.92,95％CI:1.42-6.48,P=0.005).The results of internal validation showed that the predictive accuracy of TOLAC success,as measured by the C-index,was 0.89.Conclusion This model has certain guiding value for evaluating the feasibility of trial of labor after cesarean preterm women without a history of vaginal delivery.
trial of labor after cesareanvaginal deliverypreterm birthpredictor
万方数据
维普
