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A predictive nomogram for a failed trial of labor after cesarean: A retrospective cohort study
Author(s) -
Li Hua,
Sheng Wen,
Cai Min,
Chen Qiuling,
Lin Beibei,
Zhang Weishe,
Li Wenxia
Publication year - 2022
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.15398
Subject(s) - medicine , nomogram , cephalopelvic disproportion , logistic regression , obstetrics , population , gynecology , pregnancy , caesarean section , environmental health , biology , genetics
Aim To validate risk factors and a nomogram prediction model for the failure of a trial of labor after cesarean section (TOLAC) in a Chinese population. Methods We included women who tried TOLAC between January 2017 and May 2019, grouped according to the success/failure of TOLAC. The patients were randomized 3:1 into the development and validation sets. Multivariable logistic regression analyses were used to develop a nomogram prediction model for TOLAC failure. Results In total, 535 (86.3%) of the women ( n = 620) aged 29–34 years had a successful vaginal birth after cesarean (VBAC). All women had a fully healed previous uterine incision. The univariable analyses showed that the cephalopelvic score ( p < 0.001), BMI ( p = 0.001), full engagement into the pelvis ( p < 0.001), Bishop cervical maturity score ( p < 0.001), and estimated fetal weight at admission ( p < 0.001) could enter the multivariable model. Furthermore, the multivariable analysis showed that the cephalopelvic score (OR = 0.42, 95%CI: 0.23–0.77, p = 0.005), full engagement in the pelvis (OR = 0.16, 95%CI: 0.08–0.33, p < 0.001), and Bishop cervical maturity score (OR = 0.46, 95%CI: 0.35–0.59, p < 0.001) were independent predictors of the failure of TOLAC. Conclusion This study proposes a nomogram that can assess the risk of failure of TOLAC in Chinese pregnant women. The statistical model could help clinicians know the likelihood of successful TOLAC in the clinical setting.