[摘要] 目的 建立评估剖宫产后阴道试产风险的产前预测评分公式，指导分娩方式的选择。方法 选取2019年1月至2020年12月于宁波大学附属妇女儿童医院分娩的单次剖宫产后阴道试产孕妇240例作为研究对象，根据最终分娩方式分为剖宫产后阴道分娩成功组（n=202）和失败组（n=38），采用单因素分析和多因素Logistic回归分析相关影响因素，并据此建立剖宫产后阴道分娩产前预测评分公式。结果 试产成功率84.2%，子宫破裂率0.99%。Logistic回归预测评分公式总的预测准确率为83.8%，公式的拟合程度好（χ²=8.828，P=0.357），曲线下面积为0.798。结论 阴道分娩史、子宫下段肌层厚度、引产为剖宫产后阴道分娩的独立影响因素，由这3个因素建立的剖宫产术后再次妊娠阴道试产风险预测评分公式预测效能较好，准确率较高。

[关键词] 剖宫产后阴道分娩；预测评分公式；Logistic回归分析

[中图分类号] R54" """"[文献标识码] A """""[DOI] 10.3969/j.issn.1673-9701.2025.20.003

Clinical study on prenatal prediction scoring formula of vaginal delivery after a single cesarean section

XU Shuangshuang¹， WANG Qiao²， MAO Yuan²， LI Jie²

1.Health Science Center of Ningbo University， Ningbo 315211， Zhejiang， China; 2.Department of Obstetrics， the Affiliated Women and Children’s Hospital of Ningbo University， Ningbo 315012， Zhejiang， China

[Abstract] Objective To establish a prenatal prediction scoring formula for evaluating the risk of vaginal trial delivery after cesarean section. The formula will guide the selection of delivery methods. Methods A total of 240 cases of vaginal trial delivery after cesarean section delivered in the Affiliated Women and Children’s Hospital of Ningbo University from January 2019 to December 2020 were selected as subjects. According to the final mode of delivery， they were divided into two groups： successful group（n=202） and failed group（n=38）. Single factor analysis and multivariate Logistic regression analysis were used to analyze the influencing factors of vaginal delivery after cesarean section. Based on these， prediction scoring formula was established. Results The success rate was 84.2%. The rate of uterine rupture was 0.99%. Overall prediction accuracy of the Logistic regression prediction formula was 83.8%， and fit degree of the formula was good （χ ²=8.828， P=0.357）.The area under the curve was 0.798. Conclusion History of vaginal delivery， thickness of the lower segment of uterus and induced labor are independent influencing factors for vaginal delivery after cesarean section. The prediction scoring formula established by these three factors has good prediction efficiency and high accuracy.

[Key words] Vaginal birth after cesarean; Prediction scoring formula; Logistic regression analysis

剖宫产是处理难产及妊娠合并症的重要手术。目前，剖宫产术后再次妊娠的孕妇占总分娩量的比例明显升高，这部分孕妇面临分娩方式的选择^[1]。对大多数孕妇来说，计划性剖宫产术后阴道分娩（vaginal birth after cesarean，VBAC）是一个安全的选择。然而，阴道试产存在潜在风险，如子宫破裂，产后出血和急诊子宫切除。本研究结合宁波大学附属妇女儿童医院实际VBAC情况构建预测评分公式，用以指导孕妇做出正确的决策，有利于降低子宫破裂的风险。

1" 对象与方法

1.1" 研究对象

选取2019年1月至2020年12月在宁波大学附属妇女儿童医院自愿选择VBAC的240例孕妇作为研究对象。……