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首页> 外文期刊>The journal of maternal-fetal & neonatal medicine >Risk of operative delivery for intrapartum fetal compromise in small-for-gestational-age fetuses at term: external validation of the IRIS algorithm
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Risk of operative delivery for intrapartum fetal compromise in small-for-gestational-age fetuses at term: external validation of the IRIS algorithm

机译：术语小于胎龄胎儿的胎儿胎儿患者手术递送的风险：虹膜算法的外部验证

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Objectives:Small-for-gestational-age fetuses (SGA) are at high risk of intrapartum fetal compromise requiring operative delivery. In a recent study, we developed a model using a combination of three antenatal (gestational age at delivery, parity, cerebroplacental ratio) and three intrapartum (epidural use, labor induction and augmentation using oxytocin) variables for the prediction of operative delivery due to presumed fetal compromise in SGA fetuses - the Individual RIsk aSsessment (IRIS) prediction model. The aim of this study was to test the predictive accuracy of the IRIS prediction model in an external cohort of singleton pregnancies complicated by SGA. Methods:This was an external validation study using a cohort of pregnancies from two tertiary referral centers in Spain and England. The inclusion criteria were singleton pregnancies diagnosed with an SGA fetus, defined as estimated fetal weight (EFW) below the 10th centile for gestational age at 36 weeks or beyond, which had fetal Doppler assessment and available data on their intrapartum care and pregnancy outcomes. The main outcome in this study was the operative delivery for presumed fetal compromise. External validation was performed using the coefficients obtained in the original development cohort. The predictive accuracies of models were investigated with receiver operating characteristics (ROC) curves. The Hosmer-Lemeshow test was used to test the goodness-of-fit of models and calibration plots were also obtained for visual assessment. A mobile application using the combined model algorithm was developed to facilitate clinical use. Results:Four hundred twelve singleton pregnancies with an antenatal diagnosis of SGA were included in the study. The operative delivery rate was 22.8% (n = 94). The group which required operative delivery for presumed fetal compromise had significantly fewer multiparous women (19.1 versus 47.8%,p < .001 in the total study population; 19.0 versus 43.5 and 19.2 versus 49.6%, UK and Spain cohort, respectively), lower cerebroplacental ratio (CPR) multiples of median (MoM) (median: 0.77 versus 0.92,p < .001 in the total study population; 0.77 versus 0.92 and 0.77 versus 0.92, UK and Spain cohort, respectively), more inductions of labor (74.5 versus 60.1%,p = .010 in the total study population; 85.7 versus 77.2 and 71.2% and 53.1, UK and Spain cohort, respectively) and more use of oxytocin augmentation (57.4 versus 39.3%,p = .002 in the total study population; 19.0 versus 12.0 and 68.5 and 50.4%, UK and Spain cohort, respectively) compared to those who did not require operative delivery due to presumed fetal compromise. When the original antenatal model was applied to the present cohort, we observed moderate predictive accuracy (AUC: 0.70, 95% CI: 0.64-0.76), and no signs of poor fit (p = .464). The original combined model, when applied to the external cohort, had moderate predictive accuracy (AUC: 0.72, 95% CI: 0.67-0.77) and also no signs of poor fit (p = .268) without the need for refitting. A statistically significant increase in the predictive accuracy was not achievedviarefitting of the combined model (AUC 0.76 versus 0.72,p = .060). Conclusions:Using our recently published model, the predictive accuracy for fetal compromise requiring operative delivery in term fetuses thought to be SGA was modest and showed no signs of poor fit in an external cohort. The IRIS tool for mobile devices has been developed to facilitate wide clinical use of this prediction model.
机译：目的：小胎龄胎儿（SGA）患有手术递送的胎儿妥协的高风险。在最近的一项研究中，我们使用三种产前（胎儿，脑电图，脑膜单位比）和三个内突（硬膜外使用，使用催产素）变量的组合开发了一种模型，以预测由于假定的操作递送胎儿危害在SGA胎儿中 - 个人风险评估（IRIS）预测模型。本研究的目的是测试SGA复杂的外部妊娠中的虹膜预测模型的预测准确性。方法：这是一个外部验证研究，使用来自西班牙和英格兰的两个第三节推荐中心的怀孕队列。纳入标准是诊断有SGA胎儿的单身妊娠，定义为36周或以上的胎儿年龄的估计胎儿重量（EFW），其具有胎儿多普勒评估和可在其内庭护理和怀孕结果的可用数据。这项研究的主要结果是术语胎儿妥协的手术交付。使用原始开发队列中获得的系数进行外部验证。使用接收器操作特性（ROC）曲线研究了模型的预测精度。 Hosmer-Lemeshow测试用于测试模型的健康和校准图也获得视觉评估。开发了使用组合模型算法的移动应用程序以促进临床使用。结果：研究中纳入了四百十二例单身妊娠型，均涉及SGA的产前诊断。手术递送率为22.8％（n = 94）。所要求的假定胎儿妥协所需的小组具有显着较少的多种妇女（19.1与47.8％，P <.001在总研究人口中; 19.0与43.5和19.2与49.6％，英国和西班牙队列），较低的脑电线比例（CPR）中位数（MOM）的倍数（中位数：0.77对0.92，P <.001在总研究人口中; 0.77与0.92和0.77与0.92，英国和西班牙队列，更多的劳动灌条（74.5总研究人口中的60.1％，P = .010; 85.7与77.2和71.2％和53.1，英国和西班牙队列，更多使用催产素增强（57.4与39.3％，P = .002在总研究人口中; 19.0与12.0和68.5和50.4％，英国和西班牙队列，与由于假定的胎儿妥协而没有操作交付的人相比。当原始的产前模型应用于目前的队列时，我们观察到中度的预测精度（AUC：0.70,95％CI：0.64-0.76），没有差的迹象（P = .464）。当应用于外部队列时，原始的组合模型具有适度的预测精度（AUC：0.72,95％CI：0.67-0.77），也没有不需要改装的不需要格式贴合（P = .268）。在组合模型（AUC 0.76对0.72，P = 0.060）的统计学上显着增加了预测性精度的达到效率。结论：利用我们最近发表的模型，胎儿妥协的预测准确性需要在胎儿中认为是SGA的术语是谦虚的，并且没有在外部队列中没有适合的迹象。已经开发了用于移动设备的虹膜工具以促进这种预测模型的广泛临床使用。

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