Vaginal birth after a caesarean section: the development of a Western European population-based prediction model for deliveries at term

BJOG. 2014 Jan;121(2):194-201; discussion 201. doi: 10.1111/1471-0528.12539.

Abstract

Objective: 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.

Design: Registration-based retrospective cohort study.

Setting: Five university teaching hospitals, seven non-university teaching hospitals, and five non-university non-teaching hospitals in the Netherlands.

Population: 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.

Methods: 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.

Main outcome measures: 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.

Results: 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(th) 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.

Conclusion: We developed an appropriate Western European population-based prediction model that is aimed to personalise counselling for term deliveries.

Keywords: Personalised decision-making; VBAC; prediction model; vaginal birth after caesarean.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Body Mass Index
  • Cohort Studies
  • Female
  • Fetal Weight
  • Humans
  • Labor, Induced
  • Models, Statistical*
  • Obstetric Labor Complications
  • Patient Outcome Assessment
  • Pregnancy
  • Pregnancy Trimester, Third
  • ROC Curve
  • Racial Groups
  • Retrospective Studies
  • Vaginal Birth after Cesarean*