The Build And Assessment Of The Risk Score System Of Trial Of Labor After Cesarean Section

Objective: A simple predictive score system is created for women who attempt at TOLAC(trial of labor after caesarean)at the time of admission to identify the likelihood of achieving a successful VBAC in subsequent pregnancies,which provides theoretical evidence for the doctors to select the optimal mode of delivery,it can also help those women who have decided on TOLAC but have a second thought at the time of admission.Methods: We looked into the cases from January 1st,2013 to September 30 st,2019 in Shengjing hospital,there are 332 women with a previous low-transverse cesarean delivery who attempted a vaginal birth with cephalic presentation.Women with multiple pregnancies,more than one previous cesarean procedure,or preterm delivery were excluded from the study,324 cases stayed at last,including 304 successful VBAC cases and 20 failed TOLAC cases which turned into emergency caesarean delivery.Single factor analysis was performed before logistic regression,the variables were selected by reading other relative papers as long as using clinical experiences.We created the final score system according to the regression coefficient,after which we evaluate the fitness and the sensitivity of the score system.Results: The successful VBAC rate is 93.8% in 324 cases which meet the criteria.Maternal height,scar time,previous indication of CS,preterm labor,admission labor,premature rupture of membranes and neonatal weight are the risk factors related to the outcome of TOLAC,in the score system,when the total score is more than 18,the successful TOLAC rate is more than 65%.When we bring back the status into the score system,the AUC is 0.918,which indicates great accuracy.Conclusion: For TOLAC patients whose total score are more than-6,we suggest vaginal birth,we should also pay attention to the clinical management of the labor process to guarantee the maternal and neonatal safety.