Development and validation of a risk nomogram for failed conversion from labor epidural analgesia to cesarean epidural anesthesia.
Nomogram using six routine variables predicts failed labor-to-cesarean epidural conversion well.
Development and validation of a risk nomogram for failed conversion from labor epidural analgesia to cesarean epidural anesthesia.
This study aimed to develop and validate a risk prediction nomogram for failed conversion from epidural labor analgesia to cesarean epidural anesthesia.
Parturients undergoing non-immediate cesarean section after epidural labor analgesia between January 2022 and December 2024 across two centers were retrospectively analyzed (model-development cohort: 389; external validation cohort: 129).
correctly separates failed from successful conversions most of the time, 1.0 would be perfect
The conversion failure rate was 18.5% in the model-development cohort and 18.6% in the external validation cohort.
Six predictors were incorporated into the nomogram: obstetric anesthesiologist involvement, 10-min post-analgesia VAS score, breakthrough pain, frequent rescue epidural top-ups, asymmetric sensory blockade, and programmed intermittent epidural bolus (programmed intermittent epidural bolus) pump mode.
We developed and externally validated a clinically interpretable nomogram for predicting failed labor-to-cesarean epidural conversion.
Incorporating six routinely available variables, this tool may help convert early clinical signs of inadequate epidural function into a quantitative decision aid for anesthetic planning.