Validation of a prediction model for vaginal birth after caesarean.


  • Date de publication : 2013-03-08

Référence

Chaillet N, Bujold E, Dubé E, Grobman WA. Validation of a prediction model for vaginal birth after caesarean. J Obstet Gynaecol Can. 2013;35:119-24. PubMed PMID: 23470060.

Information Complémentaire

Lien vers PubMed

Mot(s) Clé(s)

area under curve female humans pregnancy pregnancy outcome probability quebec roc curve randomized controlled trials as topic trial of labor united states vaginal birth after cesarean

Résumé

Pregnant women with a previous Caesarean section face making the decision to undergo an elective repeat Caesarean section or to attempt a trial of labour with the goal of achieving a vaginal birth after Caesarean (VBAC). One of the key factors in counselling these women is the probability of a successful VBAC. We aimed to validate a prediction model for VBAC success.We performed an analysis of women at term with one prior low-transverse Caesarean section and a live cephalic singleton pregnancy who attempted a trial of labour after Caesarean (TOLAC) at 32 hospitals in Quebec between 2008 and 2012. The individual TOLAC probabilities of success were calculated without regard to ethnicity, using a prediction model previously developed in the United States. The predictive ability of the model was assessed using receiver operating characteristic curves and the area under the curve (AUC). In addition, a calibration curve was generated by plotting the predicted and observed VBAC rates.Of 3113 eligible women who underwent TOLAC, we found an overall rate of VBAC of 75.3%. Beyond a predicted probability of 40%, both observed and predicted TOLAC success rates were similar. The accuracy of the model was high (AUC = 0.72; 95% CI 0.70 to 0.74, P < 0.001) as was the correlation between observed and predicted probabilities of TOLAC success (R² = 0.98). Finally, for women requiring induction of labour, observed and predicted probabilities were similar for a predicted probability ≥ 70%.It is possible to estimate VBAC success accurately in Quebec using a validated prediction model from the United States. This model may be used in practice without regard to ethnicity as a primary method to refine counselling during antepartum visits for women with a prior Caesarean section.