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A clinical prediction model to assess the risk of operative delivery
Author(s) -
Schuit E,
Kwee A,
Westerhuis MEMH,
Van Dessel HJHM,
Graziosi GCM,
Van Lith JMM,
Nijhuis JG,
Oei SG,
Oosterbaan HP,
Schuitemaker NWE,
Wouters MGAJ,
Visser GHA,
Mol BWJ,
Moons KGM,
Groenwold RHH
Publication year - 2012
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/j.1471-0528.2012.03334.x
Subject(s) - cephalic presentation , medicine , caesarean section , fetal distress , obstetrics , vaginal delivery , apgar score , pregnancy , gestational age , breech presentation , nomogram , gynecology , fetus , genetics , biology
Please cite this paper as: Schuit E, Kwee A, Westerhuis M, Van Dessel H, Graziosi G, Van Lith J, Nijhuis J, Oei S, Oosterbaan H, Schuitemaker N, Wouters M, Visser G, Mol B, Moons K, Groenwold R. A clinical prediction model to assess the risk of operative delivery. BJOG 2012;119:915–923. Objective To predict instrumental vaginal delivery or caesarean section for suspected fetal distress or failure to progress. Design Secondary analysis of a randomised trial. Setting Three academic and six non‐academic teaching hospitals in the Netherlands. Population 5667 labouring women with a singleton term pregnancy in cephalic presentation. Methods We developed multinomial prediction models to assess the risk of operative delivery using both antepartum (model 1) and antepartum plus intrapartum characteristics (model 2). The models were validated by bootstrapping techniques and adjusted for overfitting. Predictive performance was assessed by calibration and discrimination (area under the receiver operating characteristic), and easy‐to‐use nomograms were developed. Main outcome measures Incidence of instrumental vaginal delivery or caesarean section for fetal distress or failure to progress with respect to a spontaneous vaginal delivery (reference). Results 375 (6.6%) and 212 (3.6%) women had an instrumental vaginal delivery or caesarean section due to fetal distress, and 433 (7.6%) and 571 (10.1%) due to failure to progress, respectively. Predictors were age, parity, previous caesarean section, diabetes, gestational age, gender, estimated birthweight (model 1) and induction of labour, oxytocin augmentation, intrapartum fever, prolonged rupture of membranes, meconium stained amniotic fluid, epidural anaesthesia, and use of ST‐analysis (model 2). Both models showed excellent calibration and the receiver operating characteristics areas were 0.70–0.78 and 0.73–0.81, respectively. Conclusion In Dutch women with a singleton term pregnancy in cephalic presentation, antepartum and intrapartum characteristics can assist in the prediction of the need for an instrumental vaginal delivery or caesarean section for fetal distress or failure to progress.