{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T05:55:29Z","timestamp":1781762129851,"version":"3.54.5"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100016308","name":"Wuxi Health and Family Planning Commission","doi-asserted-by":"publisher","award":["FYKY202210"],"award-info":[{"award-number":["FYKY202210"]}],"id":[{"id":"10.13039\/501100016308","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aimed to develop and validate a risk prediction nomogram for failed conversion from epidural labor analgesia to cesarean epidural anesthesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u20130.94) and external validation (AUROC 0.89, 95% CI 0.83\u20130.96) cohorts, with acceptable calibration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1796836","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T05:30:43Z","timestamp":1781760643000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of a risk nomogram for failed conversion from labor epidural analgesia to cesarean epidural anesthesia"],"prefix":"10.3389","volume":"13","author":[{"given":"Guangyuan","family":"Su","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Affiliated Yixing Hospital of Jiangsu University","place":["Yixing, 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