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|Title:||Vaginal birth after a caesarean section: the development of a Western European population-based prediction model for deliveries at term|
Van Kuijk, S.
De Boer, K.
Van Dooren, I.
|Citation:||BJOG: An International Journal of Obstetrics and Gynaecology, 2014; 121(2):194-201|
|ENC Schoorel, SMJ van Kuijk, S Melman, JG Nijhuis, LJM Smits, R Aardenburg, K de Boer, FMC Delemarre, IM van Dooren, MTM Franssen, M Kaplan, G Kleiverda, SMI Kuppens, A Kwee, FTH Lim, BWJ Mol, FJME Roumen, JM Sikkema, E Smid-Koopman, H Visser, M Woiski, RPMG Hermens, HCJ Scheepers|
|Abstract:||OBJECTIVE: To develop and internally validate a model that predicts the outcome of an intended vaginal birth after caesarean (VBAC) for a Western European population that can be used to personalise counselling for deliveries at term. DESIGN: Registration-based retrospective cohort study. SETTING: Five university teaching hospitals, seven non-university teaching hospitals, and five non-university non-teaching hospitals in the Netherlands. POPULATION: A cohort of 515 women with a history of one caesarean section and a viable singleton pregnancy, without a contraindication for intended VBAC, who delivered at term. METHODS: Potential predictors for a vaginal delivery after caesarean section were chosen based on literature and expert opinions. We internally validated the prediction model using bootstrapping techniques. MAIN OUTCOME MEASURES: Predictors for VBAC. For model validation, the area under the receiver operating characteristic curve (AUC) for discriminative capacity and calibration-per-risk-quantile for accuracy were calculated. RESULTS: A total of 371 out of 515 women had a VBAC (72%). Variables included in the model were: estimated fetal weight greater than the 90(th) percentile in the third trimester; previous non-progressive labour; previous vaginal delivery; induction of labour; pre-pregnancy body mass index; and ethnicity. The AUC was 71% (95% confidence interval, 95% CI = 69-73%), indicating a good discriminative ability. The calibration plot shows that the predicted probabilities are well calibrated, especially from 65% up, which accounts for 77% of the total study population. CONCLUSION: We developed an appropriate Western European population-based prediction model that is aimed to personalise counselling for term deliveries.|
|Keywords:||Personalised decision-making; prediction model; vaginal birth after caesarean; VBAC|
|Rights:||© 2013 Royal College of Obstetricians and Gynaecologists|
|Appears in Collections:||Medicine publications|
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