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Construction and Validation of a Prediction Model for Conversion to Cesarean Section in Primiparous Women Receiving
1Department of Obstetrics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, Jiangsu, People's Republic of China.
Purpose:
To develop and validate a clinical prediction model for intrapartum conversion to cesarean section in primiparous women receiving epidural labor analgesia.
Patients And Methods:
This retrospective cohort study included 1020 primiparous women who received epidural labor analgesia at a tertiary hospital in Wuxi, China. The model was developed to estimate cesarean conversion risk within this specific clinical cohort. Participants who delivered between March and December 2023 comprised the training cohort, whereas those who delivered between January and March 2024 comprised the validation cohort. Maternal, fetal, and intrapartum variables were extracted from electronic medical records, anesthesia records, and intrapartum fetal monitoring systems. A multivariable logistic regression model was developed to predict conversion to cesarean section, and a nomogram was constructed based on the final model. Model discrimination and calibration were assessed using the area under the receiver operating characteristic curve (AUC), the Hosmer-Lemeshow test, and calibration plots. Clinical utility was evaluated using decision curve analysis.
Results:
The rate of conversion to cesarean section was 15.9% in the training cohort and 15.3% in the validation cohort. Six variables were identified as independent predictors of cesarean conversion: maternal age, intrapartum temperature, amniotic fluid characteristics, fetal heart rate status, use of oxytocin, and rupture of membranes during the first stage of labor. The prediction model showed good discrimination, with an AUC of 0.810 (sensitivity 0.822, specificity 0.606) in the training cohort. In the validation cohort, the AUC was 0.763 (sensitivity 0.786, specificity 0.592), indicating consistent predictive performance.
Conclusion:
This prediction model provides reliable risk estimation for conversion to cesarean section within a specific cohort of primiparous women receiving epidural labor analgesia. It may support early intrapartum risk stratification and individualized clinical decision-making. Further multicenter studies are warranted to assess its generalizability.
