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Development and Validation of Predictive Models for Vaginal Birth After Cesarean Delivery in China

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单位: [1]Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China [2]Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China [3]Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, Guangdong, P.R. China [4]Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangzhou, Guangdong, P.R. China [5]Department of Obstetrics and Gynecology, Guangzhou Huadu District Maternal and Child Health Hospital, Guangzhou, Guangdong, P.R. China [6]Department of Obstetrics and Gynecology, Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Guangzhou, Guangdong, P.R. China [7]Department of Obstetrics and Gynecology, Northwest Women’s and Children’s Hospital, Xian, Shaanxi, P.R. China [8]Department of Obstetrics and Gynecology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei,P.R. China [9]Department of Obstetrics and Gynecology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henen, P.R. China [10]Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P.R. China [11]Department of Obstetrics and Gynecology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, P.R. China [12]Department of Obstetrics and Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China [13]Department of Obstetrics and Gynecology, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China [14]Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, P.R. China
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关键词: Cesarean Section Repeat Pregnancy Complications Trial of Labor Vaginal Birth after Cesarean

摘要:
Background: The rate of delivery by cesarean section is rising in China, where vaginal birth after cesarean (VBAC) is in its early stages. There are no validated screening tools to predict VBAC success in China. The objective of this study was to identify the variables predicting the likelihood of successful VBAC to create a predictive model. Material/Methods: This multicenter, retrospective study included 1013 women at >= 28 gestational weeks with a vertex singleton gestation and 1 prior low-transverse cesarean from January 2017 to December 2017 in 11 public tertiary hospitals within 7 provinces of China. Two multivariable logistic regression models were developed: (1) at a first-trimester visit and (2) at the pre-labor admission to hospital. The models were evaluated with the area under the receiver operating characteristic curve (AUC) and internally validated using k-fold cross-validation. The pre-labor model was calibrated and a graphic nomogram and clinical impact curve were created. Results: A total of 87.3% (884/1013) of women had successful VBAC, and 12.7% (129/1013) underwent unplanned cesarean delivery after a failed trial of labor. The AUC of the first-trimester model was 0.661 (95% confidence interval [CI]: 0.61-0.712), which increased to 0.758 (95% CI: 0.715-0.801) in the pre-labor model. The pre-labor model showed good internal validity, with AUC 0.743 (95% CI: 0.694-0.785), and was well calibrated. Conclusions: VBAC provides women the chance to experience a vaginal delivery. Using a pre-labor model to predict success-ful VBAC is feasible and may help choose mode of birth and contribute to a reduction in cesarean delivery rate.

基金:

基金编号: 2016YFC1000405 2017YFC1001402 2018YFC1004104 2018YFC10029002 81830045 81671533 81571518 81971415 2020A1515010273

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出版当年[2019]版:
大类 | 4 区 医学
小类 | 4 区 医学:研究与实验
最新[2025]版:
大类 | 4 区 医学
小类 | 4 区 医学:研究与实验
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出版当年[2018]版:
Q3 MEDICINE, RESEARCH & EXPERIMENTAL
最新[2023]版:
Q3 MEDICINE, RESEARCH & EXPERIMENTAL

影响因子: 最新[2023版] 最新五年平均 出版当年[2018版] 出版当年五年平均 出版前一年[2017版] 出版后一年[2019版]

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第一作者单位: [1]Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
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通讯机构: [1]Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P.R. China [3]Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, Guangdong, P.R. China [4]Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangzhou, Guangdong, P.R. China
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