Abstract:【Objective】 To explore the predictive efficacy of cervical maturity score (Bishop score) combined with modified vaginal birth after cesarean (VBAC) score for VBAC failure. 【Methods 】A total of 400 parturients undergoing trial of labor after cesarean section who delivered in our hospital from January 2020 to May 2023 were selected. According to whether vaginal delivery was successful, the parturients were divided into the success group (n=295) and the failure group (n=105). The Bishop score, modified VBAC score and general data were compared between the two groups. Multivariate stepwise Logistic regression model was used to analyze the influencing factors of VBAC failure. Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of Bishop score, modified VBAC score and their combination for VBAC failure. 【Results 】The Bishop score and modified VBAC score in the success group were higher than those in the failure group (P<0.05), the previous vaginal delivery rate was higher than that in the failure group (P<0.05), the time since the last cesarean section was longer than that in the failure group (P<0.05), and the estimated fetal weight was lower than that in the failure group (P<0.05). Multivariate stepwise Logistic regression model analysis showed that previous vaginal delivery history, time since last cesarean section, estimated fetal weight, Bishop score and modified VBAC score were the influencing factors of VBAC failure (P<0.05). ROC curve analysis showed that the AUC of Bishop score and modified VBAC score for predicting VBAC failure was 0.831 and 0.832, respectively, and the AUC of their combination for predicting VBAC failure was 0.916. 【Conclusion】The combination of Bishop score and modified VBAC score has high predictive efficacy for VBAC failure.
[1] VAAJALA M, LIUKKONEN R, PONKILAINEN V, et al. Delivery mode and fetal outcome in attempted vaginal deliveries after previous cesarean section: a nationwide register-based cohort study in Finland[J].J Matern Fetal Neonatal Med,2023, 36(1):2198062. [2] VINCE K, POLJIČANIN T, MATIJEVIĆ R. Comparison of transvaginal sonographic cervical length measurement and Bishop score for predicting labour induction outcomes[J].J Perinat Med,2022, 50(9):1198-1202. [3] RAJA J F, BANGASH K T, MAHMUD G. VBAC scoring: successful vaginal delivery in previous one caesarean section in induced labour[J].J Pak Med Assoc,2013, 63(9):1147. [4] BISHOP E H. Pelvic scoring for elective induction[J].Obstet Gynecol,1964, 8(24):266-268. [5] 周爱红, 杨菊芬. 改良VBAC评分法对瘢痕子宫再妊娠产妇自然分娩成功率的预测价值研究[J].中国优生与遗传杂志, 2021, 27(4):542-545. [6] 韩晓慧, 王丹, 李莉.基于德尔菲法构建剖宫产后阴道分娩产科干预质量敏感指标的评价体系[J].医学临床研究, 2025, 42(5):776-779. [7] 张冬梅, 王雅莉, 刘文枝, 等.剖宫产术后再次妊娠阴道试产评分表的建立及应用[J].中华妇产科杂志, 2022, 57(5):339-345. [8] 陈晓明, 陈震宇, 孙静莉, 等.剖宫产术后再次妊娠经阴道分娩预测模型的建立及验证[J].现代妇产科进展, 2021, 30(8):601-605. [9] 虞金哲, 刘彩霞, 王紫微, 等.剖宫产术后阴式试产成功预测模型建立及初步验证[J].中国实用妇科与产科杂志, 2021, 37(7):782-785. [10] HOSOYA S, MAEDA Y, OGAWA K, et al. Predictive factors for vaginal delivery by induction of labor in uncomplicated pregnancies at 40-41 gestational weeks: A Japanese prospective single-center cohort study[J].J Obstet Gynaecol Res,2023, 49(3):920-929. [11] 齐新颖, 杨风桢, 邢艳萍, 等. 改良VBAC评分法在剖宫产后阴道试产中的应用[J].基因组学与应用生物学, 2020, 39(4):95-98. [12] LAZAROU A, OESTERGAARD M, NETZL J, et al. Vaginal birth after cesarean (VBAC): Fear it or dare it? An evaluation of potential risk factors[J].J Perinat Med,2021, 49(7):773-782.