| Background: The high rate of cesarean section in the world has become an important problem to be solved urgently.The short-term and long-term risks of cesarean delivery are also issues that need to be considered by clinicians.Therefore,it is very important to reduce cesarean section without medical indications.As one of the most common interventions in modern obstetrics,induction of labor(IOL)can help reduce the rate of cesarean section.IOL is defined as artificial stimulation to initiate uterine contractions before the spontaneous onset of labor.Clinicians will evaluate the cervical condition before induction of labor.If the cervical condition is poor,it is necessary to ripen the cervix first,and the cervical condition is closely related to the success of subsequent induction.At present,the methods to ripen the cervix are mainly divided into mechanical and pharmaceutical methods.The double-balloon catheter is evolved from the Foley catheter which is a mechanical method used for cervical ripening.Objective: To assess antenatal factors associated with successful induction of labor and to develop a nomogram-based model to predict the likelihood of vaginal delivery after placement of a double-balloon catheter;Method: From January 2020 to December 2021,a retrospective cohort study was conducted in the xxx Hospital.According to the time of admission,869 pregnant women who using double-balloon catheters were divided into the model training cohort(n = 500)and the model validation cohort(n = 369).In the model training cohort,factors related to the success of labor induction after cervical maturation with double-balloon catheter were explored,variables with P < 0.05 in univariate analysis and clinically significant variables were included in multivariate logistic regression analysis,and a logistic regression-based column graph model was developed.The receiver operating characteristic curve(ROC curve)was used to evaluate the model performance Internal,and verification was carried out using 10-fold cross validation.The calibration curve was used to visualize the results of the Hosmer-Lemeshow goodness-of-fit test.Finally,the model was verified in the model validation cohort.Result: Of the women who used double-balloon catheters before IOL,77.2%(671/869)had vaginal delivery.In the model training cohort,the cervical scores of women in the cesarean section group and the vaginal delivery group were improved after the placement of double-balloon catheters(p < 0.05).The cervical conditions of women in the vaginal delivery group before and after the placement of double-balloon catheters were more mature than those in the cesarean delivery group(p < 0.05).The maternity age,height,history of vaginal delivery,abdominal circumference,hypertensive disorders of pregnancy(HDP),thyroid disorders,epidural request,estimated fetal weight,amniotic fluid index(AFI),meconium-stained amniotic fluid were independently associated with vaginal delivery in the model training group.An area under the receiver operating characteristic curve(AUC)in the prediction model was 0.853(95% CI: 0.814-0.892)in the training cohort.When the cut-off value was 0.627,the specificity,sensitivity,accuracy,positive predictive value and negative predictive value of the model were 68.3%,87.0%,82.4%,89.4% and 63.2%,respectively.The average AUC obtained by internal verification was 0.770.The AUC of the model validation group was 0.780(95%CI: 0.726-0.833).Conclusion: As a mechanical method to promote cervical ripening,the double-balloon catheter can effectively promote cervical softening and improve the bishop score.Our developed preoperative nomogram model can successfully be used to evaluate the likelihood of vaginal delivery based on simple clinical variables that may be useful for clinical decision-making. |
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