Analýza prediktorů neplánovaného císařského řezu u nullipar

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Authors: P. Krepelka ^1,2; I. Urbánková ¹; L. Krofta ^1,2; J. Hanacek ^1,2; J. Feyereisl ^1,2
Authors‘ workplace: Institute for the Care of Mother and Child, Prague, head J. Feyereisl, MD, Ph. D., assoc. prof. ¹; Department of Obstetrics and Gynaecology, Third Faculty of Medicine, Charles University, Prague, head L. Rob, MD, Ph. D., prof., Data availability statement: DOI: 10. 6084/m9. figshare. 6983246. ²
Published in: Ceska Gynekol 2020; 85(6): 375-384
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Overview

Cíl práce: Analýza prediktorů neplánovaného císařského řezu u nullipar.

Typ studie: Prospektivní kohortová studie.

Název a sídlo pracoviště: Ústav pro péči o matku a dítě, Praha.

Metodika: Soubor tvořily nulipary rodící mezi 37. a 42. týdnem s jednočetnou a nízkorizikovou graviditou, s plodem v poloze podélné hlavičkou a bez primární indikace pro císařský řez. Byly analyzovány vybrané prenatální a intranatální faktory ve vztahu k akutnímu císařskému řezu v indikaci zástavy progrese porodu a/nebo hypoxie plodu. Pomocí logistické regresní analýzy a metody klasifikačního stromu bylo testováno pět predikčních modelů.

Výsledky: V souboru 3728 nulipar byl císařský řez proveden u 908 (24,4 %) žen. Všechny modely logistické regrese byly srovnatelné (ROC 0,837–0,0881) a jako nejvýznamnější rizikové faktory byly identifikovány zadní postavení (OPP) plodu, věk matky a použití epidurální analgezie. Spontánní nástup porodu, podání oxytocinu a vyšší tělesná výška rodičky snižují pravděpodobnost akutního císařského řezu. Schopnost modelů předpovědět vaginální porod byla 95,7–96,3 % a 58,5–61,8 % pro predikci císařského řezu. Metoda klasifikačního stromu (ROC 0,860–0,861) identifikovala podobné rizikové faktory, jako je zadní postavení plodu, užití peridurální analgezie a absence spontánního nástupu porodu. Predikční schopnosti byly podobné s hodnotami 94,5–96,4 % pro vaginální porod a 64,6–59,0% pro císařský řez.

Závěr: Zadní postavení plodu je nejvýznamnějším prediktorem neúspěšného vaginálního porodu.

Klíčová slova:

zadní postavení – peridurální analgezie – prediktivní modely – vaginální porod – císařský řez

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