初产妇引产后中转剖宫产预测模型的建立OA

Objective:To establish a prediction model for cesarean delivery after induction(CDaI)in primiparous women based on real-world clinical data.Methods:A total of 3 069 primiparous women with full-term pregnancies who underwent induction of labor at Songjiang Maternal and Child Health Hospital in Shanghai from March 1,2020 to December 31,2023 were selected and divided into the CDaI group(n=970)and the vaginal delivery(VD)group(n=2 099)based on the mode of delivery.The clinical and pathological characteristics of the two groups were compared.Logistic regression and LASSO regression models were used to screen the predictive factors.The predictive ability of the model was evaluated using the receiver operating characteristic(ROC)curve,and the goodness-of-fit of the model was tested using the Hosmer-Lemeshow goodness-of-fit test.Results:The CDaI group had significantly higher age,gestational age at delivery,pre-pregnancy body mass index(BMI),gestational weight gain,oxytocin dosage,proportion of pregnancies achieved through assisted reproductive technology(ART),and incidence of hypertensive disorders of pregnancy(HDP)compared with the VD group(all P<0.05),but the proportion of epidural labor analgesia and doula-assisted delivery in the CDaI group was significantly lower than that in the VD group(both P<0.05).Logistic regression analysis showed that age,gestational age at delivery,pre-pregnancy BMI,gestational weight gain,induction method,oxytocin dosage,epidural labor analgesia,and doula-assisted delivery were independent influencing factors for CDaI in primiparous women.The AUC of the prediction model in the training set and validation set were 0.83 and 0.82,respectively.The Hosmer-Lemeshow goodness-of-fit test showed that the model had a good fit(P=0.62,0.38).The AUC of the prediction model constructed using the 8 variables selected by LASSO regression was 0.82.Conclusion:A prediction model for CDaI in primiparous women based on 8 clinical routine variables,including age,gestational age at delivery,pre-pregnancy BMI,gestational weight gain,induction method,oxytocin dosage,epidural labor analgesia and doula-assisted delivery,was established and exhibited good performance.