Daniel Gabbai, Itamar Gilboa, Emmanuel Attali, Yariv Yogev, Anat Lavie
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引用次数: 0
摘要
目的确定肥胖产妇产前剖宫产(CD)风险的风险因素,并设计一个基于临床的预测模型:方法:2012 年至 2022 年期间,在一家三级医疗中心开展了一项回顾性队列研究,纳入了所有妊娠前体重指数(BMI)≥30 且计划试产的连续产妇。通过单变量和多变量分析,比较了阴道分娩产妇和产前检查产妇的孕产妇和新生儿特征。根据相对风险制定了一个特定的风险预测评分,以预测是否需要进行产前检查:结果:在研究队列中的 5663 名肥胖产妇中,424 人(7.5%)接受了产内 CD,5239 人(92.5%)经阴道分娩。CD的独立风险因素包括产妇年龄大于35岁、妊娠前体重指数类别(体重指数35-40和体重指数大于40)、无胎儿、硬膜外麻醉、引产、分娩过程中使用抗生素、多胎妊娠、既往子宫疤痕和先兆子痫。产后 CD 预测评分模型具有 85% 的灵敏度和 70% 的特异性:护理人员可利用产前 CD 评分模型为面临分娩方式决定的肥胖产妇提供更明智的咨询。
Prediction of intrapartum cesarean delivery among women with obesity: A retrospective cohort study
Objective
To determine risk factors and design a clinically based predictive model for the risk of intrapartum cesarean delivery (CD) in women with obesity.
Methods
A retrospective cohort study was conducted in a single tertiary medical center between 2012 and 2022 and included all consecutive women with a pre-gestational body mass index (BMI) ≥30 who planned a trial of labor. Uni- and multivariate analyses compared maternal and neonatal characteristics of women who delivered vaginally to those who underwent intrapartum CD. A specific risk prediction score was developed in accordance with the relative risk to predict the need for intrapartum CD.
Results
Of the 5663 women with obesity included in the study cohort, 424 (7.5%) underwent intrapartum CD and 5239 (92.5%) delivered vaginally. The independent risk factors for CD were maternal age >35 years, pre-gestational BMI category (BMI 35–40 and BMI >40), nulliparity, epidural anesthesia, induction of labor, antibiotic administration during labor, multiple gestation, previous uterine scar, and pre-eclampsia. The intrapartum CD prediction score model demonstrated predictive performance with 85% sensitivity and 70% specificity.
Conclusion
Score model for intrapartum CD can be used by caregivers to offer a more informed consultation to women with obesity facing the decision of mode of delivery.
期刊介绍:
The International Journal of Gynecology & Obstetrics publishes articles on all aspects of basic and clinical research in the fields of obstetrics and gynecology and related subjects, with emphasis on matters of worldwide interest.