arXiv:2507.21330stat.APcs.LG2025-07

用孕早期数据预测剖宫产后顺产成功率,模型准确率达73%。

Predicting VBAC Outcomes from U.S. Natality Data using Deep and Classical Machine Learning Models

  • 基于64万例数据,用深度学习与传统机器学习建模预测顺产可能。
  • 多层感知机模型AUC达0.7287,优于逻辑回归和XGBoost。
  • 关键影响因素包括孕前体重、教育水平、既往分娩次数等。

准确预测剖宫产后试产(TOLAC)结局对指导产前咨询和降低分娩风险至关重要。本研究利用美国疾病控制与预防中心(CDC WONDER)2017–2023年出生数据集中的643,029例TOLAC案例,构建监督学习模型预测剖宫产后阴道分娩(VBAC)结果。在筛选出单胎、有1或2次既往剖宫产且包含47个产前特征完整数据后,训练了逻辑回归、XGBoost和多层感知机(MLP)三种分类器。MLP表现最佳,AUC为0.7287,其次为XGBoost(AUC=0.727),均高于逻辑回归基线(AUC=0.709)。为缓解类别不平衡问题,对MLP采用类别权重,并在XGBoost中实现自定义损失函数。评估指标包括ROC曲线、混淆矩阵及精确率-召回率分析。逻辑回归系数显示,产妇体质指数(BMI)、教育水平、产次、合并症及产前保健指标为关键预测因子。结果表明,常规收集的早孕期变量可支持可扩展且中等性能的VBAC预测模型,具备临床决策支持潜力,尤其适用于缺乏产时专业数据的场景。

原文摘要 · Abstract (English)

Accurately predicting the outcome of a trial of labor after cesarean (TOLAC) is essential for guiding prenatal counseling and minimizing delivery-related risks. This study presents supervised machine learning models for predicting vaginal birth after cesarean (VBAC) using 643,029 TOLAC cases from the CDC WONDER Natality dataset (2017-2023). After filtering for singleton births with one or two prior cesareans and complete data across 47 prenatal-period features, three classifiers were trained: logistic regression, XGBoost, and a multilayer perceptron (MLP). The MLP achieved the highest performance with an AUC of 0.7287, followed closely by XGBoost (AUC = 0.727), both surpassing the logistic regression baseline (AUC = 0.709). To address class imbalance, class weighting was applied to the MLP, and a custom loss function was implemented in XGBoost. Evaluation metrics included ROC curves, confusion matrices, and precision-recall analysis. Logistic regression coefficients highlighted maternal BMI, education, parity, comorbidities, and prenatal care indicators as key predictors. Overall, the results demonstrate that routinely collected, early-pregnancy variables can support scalable and moderately high-performing VBAC prediction models. These models offer potential utility in clinical decision support, particularly in settings lacking access to specialized intrapartum data.

医疗预测机器学习分娩预测

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