Development of a cross‐validated model for predicting emergency cesarean for intrapartum fetal compromise at term. Issue 1 (16th October 2019)

• Record Type: Journal Article
• Authors: Flatley, Christopher; Gibbons, Kristen Stacey; Hurst, Cameron; Kumar, Sailesh
• Is Part Of: International journal of gynaecology and obstetrics. Volume 148:Issue 1(2020)
• Page Start: 41
• Page End: 47
• Publication Date: 2019-10-16
• Subjects: Cerebroplacental ratio -- Doppler -- Emergency cesarean -- Estimated fetal weight -- Fetal compromise -- Fetal distress; Gynecology -- Periodicals; Obstetrics -- Periodicals; Electronic journals; 618
• DOI: 10.1002/ijgo.12979
• Languages: English
• ISSNs: 0020-7292

Abstract

Abstract: Objectives: To develop a model for predicting emergency cesarean for fetal distress (ECFD) at term using a combination of maternal and late pregnancy ultrasound parameters measured at more than 36 gestational weeks. Methods: A study of prospectively collected data, including ultrasound scans at 36–38 weeks, for singleton non‐anomalous deliveries at Mater Mother's Hospital, Brisbane, Australia, between January 2010 and April 2017. Univariable and multivariable mixed‐effects generalized linear models were generated. The final model was validated by the K‐fold cross validation technique. Results: Overall, 5439 women met the inclusion criteria; of these, 230 (4.2%) underwent ECFD. There were more nulliparous women and women with induction of labor (IOL) in the ECFD cohort (both P < 0.001). ECFD neonates had lower z ‐scores for estimated fetal weight (EFW), cerebroplacental ratio (CPR), and middle cerebral artery pulsatility index; and higher scores for umbilical artery pulsatility index. Ethnicity, nulliparity, IOL, EFW z ‐score, and CPR z ‐score were included in the final prediction model, which showed high accuracy with an area under the receiver operator characteristic curve of 0.77. Conclusion: The study shows that a prediction model combining the continuous standardized measures of CPR and EFW and several maternal factors was able to identify ECFD with improved accuracy. Abstract : The model can identify at‐risk fetuses prenatally and might provide management options for women with known risk of emergency cesarean for intrapartum fetal compromise.