ArticleFrontiers in medicine2026
Development and validation of a risk nomogram for failed conversion from labor epidural analgesia to cesarean epidural anesthesia.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: This study aimed to develop and validate a risk prediction nomogram for failed conversion from epidural labor analgesia to cesarean epidural anesthesia. Patients and methods: 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). Potential risk factors were screened by univariate analysis in the training cohort, and six independent predictors were identified using multivariable logistic regression. A predictive model was then developed based on these predictors and validated using external data. Model performance was evaluated by discrimination (AUROC), calibration, and internal/external validation. Results: 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 (PIEB) pump mode. The model showed good discrimination in both the training (AUROC 0.89, 95% CI 0.85-0.94) and external validation (AUROC 0.89, 95% CI 0.83-0.96) cohorts, with acceptable calibration. Conclusion: 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.
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