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| Influencing factors of the successful vaginal birth after cesarean section and the construction of its regression model |
| Shanghai No.1 Maternity and Child Health Care Hospital, Shanghai, 200120 |
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Abstract To analyze the influencing factors of the successful vaginal birth after cesarean section (VBAC), and to construct its predictive regression model, so as to provide reference for the consultation and guidance of delivery mode of the repregnant women after cesarean section. Methods: The clinical data of 172 pregnant women who underwent trial of labor after caesarean (TOLAC) in the hospital from August 2020 to August 2022 were collected retrospectively. According to the outcomes of the trial of labor, these women were divided into group A (women with VBAC success) and group B (women with cesarean section after VBAC failure). The maternal baseline data were collected. Univariate analysis was used to analyze the possible influencing factors of VBAC success, and multivariate logistic regression analysis was used to determine the independent influencing factors of VBAC success. The predictive regression model was constructed, and the Hosmer Lemeshow test was used to evaluate the goodness of fit of this predictive regression model. Receiver operating characteristic (ROC) curve was used to verify the predictive value of this regression model. Results: Among 172 women, there were 131 (76.2%) cases in group A and 41 (23.8%) cases in group B. There were significant differences in the age, the rates of both dystocia and gestational hypertension as the indications of previous cesarean section, the value of body mass index (BMI) at admission, the cervical maturity (Bishop) score, the thickness of lower uterine segment, and the value of fetal body mass of the women between the two groups (P<0.05). Multivariate logistic regression analysis showed that the age, the rate of dystocia in previous cesarean section indications, the value of BMI at admission, the Bishop score, and the value of fetal body mass of the women were all the independent factors influencing their success of VBAC. Hosmer Lemeshow test showed thatχ2=5.617 and P=0.690, which certified that the goodness of fit of the model was better and the constructed model was valid. ROC curve analysis showed that the area under the curve (AUC) of the regression model for predicting the success of VBAC was 0.934, with a critical value of 0.785. The sensitivity, the specificity, the accuracy, the positive predictive value, and the negative predictive value of which were 84.7%, 90.2%, 86.1%, 96.5%, and 64.9%, respectively. Conclusion: The age, the indication of the previous cesarean section as dystocia, the value of BMI at admission, the Bishop score, and the value of fetal body mass of the women are significantly correlated with their VBAC success, and the regression model based on which has good predictive effect for the success of VBAC.
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