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Predicting successful intended vaginal delivery after previous caesarean section: external validation of two predictive models in a Dutch nationwide registration‐based cohort with a high intended vaginal delivery rate
Author(s) -
Schoorel ENC,
Melman S,
Kuijk SMJ,
Grobman WA,
Kwee A,
Mol BWJ,
Nijhuis JG,
Smits LJM,
Aardenburg R,
Boer K,
Delemarre FMC,
Dooren IM,
Franssen MTM,
Kleiverda G,
Kaplan M,
Kuppens SMI,
Lim FTH,
Sikkema JM,
SmidKoopman E,
Visser H,
Vrouenraets FPJM,
Woiski M,
Hermens RPMG,
Scheepers HCJ
Publication year - 2014
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12605
Subject(s) - medicine , caesarean section , obstetrics , receiver operating characteristic , population , vaginal delivery , body mass index , pregnancy , cohort , contraindication , gestational age , gynecology , genetics , alternative medicine , environmental health , pathology , biology
Objective To externally validate two models from the USA (entry‐to‐care [ ETC ] and close‐to‐delivery [ CTD ]) that predict successful intended vaginal birth after caesarean ( VBAC ) for the Dutch population. Design A nationwide registration‐based cohort study. Setting Seventeen hospitals in the Netherlands. Population Seven hundred and sixty‐three pregnant women, each with one previous caesarean section and a viable singleton cephalic pregnancy without a contraindication for an intended VBAC . Methods The ETC model comprises the variables maternal age, prepregnancy body mass index ( BMI ), ethnicity, previous vaginal delivery, previous VBAC and previous nonprogressive labour. The CTD model replaces prepregnancy BMI with third‐trimester BMI and adds estimated gestational age at delivery, hypertensive disease of pregnancy, cervical examination and induction of labour. We included consecutive medical records of eligible women who delivered in 2010. For validation, individual probabilities of women who had an intended VBAC were calculated. Main outcome measures Discriminative performance was assessed with the area under the curve ( AUC ) of the receiver operating characteristic and predictive performance was assessed with calibration plots and the Hosmer–Lemeshow (H‐L) statistic. Results Five hundred and fifteen (67%) of the 763 women had an intended VBAC ; 72% of these (371) had an actual VBAC . The AUC s of the ETC and CTD models were 68% (95% CI 63–72%) and 72% (95% CI 67–76%), respectively. The H‐L statistic showed a P ‐value of 0.167 for the ETC model and P = 0.356 for the CTD model, indicating no lack of fit. Conclusion External validation of two predictive models developed in the USA revealed an adequate performance within the Dutch population.