Vaginal birth after a caesarean section: the development of a Western European population‐based prediction model for deliveries at term. (January 2014)

• Record Type: Journal Article
• Authors: Schoorel, ENC; van, SMJ; Melman, S; Nijhuis, JG; Smits, LJM; Aardenburg, R; de, K; Delemarre, FMC; van, IM; Franssen, MTM; Kaplan, M; Kleiverda, G; Kuppens, SMI; Kwee, A; Lim, FTH; Mol, BWJ; Roumen, FJME; Sikkema, JM; Smid‐Koopman, E; Visser, H; Woiski, M; Hermens, RPMG; Scheepers, HCJ
• Is Part Of: BJOG. Volume 121:Number 2(2014:Feb.)
• Page Start: 194
• Page End: 201
• Publication Date: 2014-01
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12539
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12539-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12539-sec-0001" sec-type="section"> <title>Objective</title> <p>To develop and internally validate a model that predicts the outcome of an intended vaginal birth after caesarean (VBAC) for a Western European population that can be used to personalise counselling for deliveries at term.</p> </sec> <sec id="bjo12539-sec-0002" sec-type="section"> <title>Design</title> <p>Registration‐based retrospective cohort study.</p> </sec> <sec id="bjo12539-sec-0003" sec-type="section"> <title>Setting</title> <p>Five university teaching hospitals, seven non‐university teaching hospitals, and five non‐university non‐teaching hospitals in the Netherlands.</p> </sec> <sec id="bjo12539-sec-0004" sec-type="section"> <title>Population</title> <p>A cohort of 515 women with a history of one caesarean section and a viable singleton pregnancy, without a contraindication for intended VBAC, who delivered at term.</p> </sec> <sec id="bjo12539-sec-0005" sec-type="section"> <title>Methods</title> <p>Potential predictors for a vaginal delivery after caesarean section were chosen based on literature and expert opinions. We internally validated the prediction model using bootstrapping techniques.</p> </sec> <sec id="bjo12539-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>Predictors for VBAC. For model validation, the area under the receiver operating characteristic curve (AUC) for discriminative capacity and calibration‐per‐risk‐quantile for accuracy were calculated.</p> </sec> <sec id="bjo12539-sec-0007" sec-type="section"> <title>Results</title> <p>A total of 371 out of 515 women had a VBAC (72%). Variables included in the model were: estimated fetal weight greater than the 90<sup>th</sup> percentile in the third trimester; previous non‐progressive labour; previous vaginal delivery; induction of labour; pre‐pregnancy body mass index; and ethnicity. The AUC was 71% (95% confidence interval, 95% CI = 69–73%), indicating a good discriminative ability. The calibration plot shows that the predicted probabilities are well calibrated, especially from 65% up, which accounts for 77% of the total study population.</p> </sec> <sec id="bjo12539-sec-0008" sec-type="section"> <title>Conclusion</title> <p>We developed an appropriate Western European population‐based prediction model that is aimed to personalise counselling for term deliveries.</p> </sec> </abstract>