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CC BY-NC-ND 4.0 · AJP Rep 2017; 07(01): e31-e38
DOI: 10.1055/s-0037-1599129
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Validation of a Prediction Model for Vaginal Birth after Cesarean Delivery Reveals Unexpected Success in a Diverse American Population

Melanie Mai Maykin
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
2   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
,
Amanda J. Mularz
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
3   Department of Maternal-Fetal Medicine, Obstetrix Medical Group of Houston, Shenandoah, Texas
,
Lydia K. Lee
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
,
Stephanie Gaw Valderramos
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
2   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
› Author Affiliations
Further Information

Publication History

28 July 2016

03 January 2017

Publication Date:
28 February 2017 (online)

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Abstract

Objective To investigate the validity of a prediction model for success of vaginal birth after cesarean delivery (VBAC) in an ethnically diverse population.

Methods We performed a retrospective cohort study of women admitted at a single academic institution for a trial of labor after cesarean from May 2007 to January 2015. Individual predicted success rates were calculated using the Maternal–Fetal Medicine Units Network prediction model. Participants were stratified into three probability-of-success groups: low (<35%), moderate (35–65%), and high (>65%). The actual versus predicted success rates were compared.

Results In total, 568 women met inclusion criteria. Successful VBAC occurred in 402 (71%), compared with a predicted success rate of 66% (p = 0.016). Actual VBAC success rates were higher than predicted by the model in the low (57 vs. 29%; p < 0.001) and moderate (61 vs. 52%; p = 0.003) groups. In the high probability group, the observed and predicted VBAC rates were the same (79%).

Conclusion When the predicted success rate was above 65%, the model was highly accurate. In contrast, for women with predicted success rates <35%, actual VBAC rates were nearly twofold higher in our population, suggesting that they should not be discouraged by a low prediction score.

Keywords

vaginal birth after cesarean - trial of labor after cesarean - MFMU VBAC calculator - VBAC success

Note

Presented in part in poster format at the 70th Annual Meeting of the Obstetrical and Gynecological Society of Southern California, May 8–9, 2015, Marina del Rey, California.


 

  • References

  • 1 Guise JM, Denman MA, Emeis C. , et al. Vaginal birth after cesarean: new insights on maternal and neonatal outcomes. Obstet Gynecol 2010; 115 (06) 1267-1278
    CrossrefPubMedGoogle Scholar
  • 2 Grobman WA, Lai Y, Landon MB. , et al; National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU). Development of a nomogram for prediction of vaginal birth after cesarean delivery. Obstet Gynecol 2007; 109 (04) 806-812
    CrossrefPubMedGoogle Scholar
  • 3 Calculator – (MFMU) Network. VBAC calculator. Available at: https://mfmu.bsc.gwu.edu/PublicBSC/MFMU/VGBirthCalc/vagbirth.html . Retrieved November 19, 2015
    PubMedGoogle Scholar
  • 4 Costantine MM, Fox K, Byers BD. , et al. Validation of the prediction model for success of vaginal birth after cesarean delivery. Obstet Gynecol 2009; 114 (05) 1029-1033
    CrossrefPubMedGoogle Scholar
  • 5 Chaillet N, Bujold E, Dubé E, Grobman WA. Validation of a prediction model for vaginal birth after caesarean. J Obstet Gynaecol Can 2013; 35 (02) 119-124
    PubMedGoogle Scholar
  • 6 Yokoi A, Ishikawa K, Miyazaki K, Yoshida K, Furuhashi M, Tamakoshi K. Validation of the prediction model for success of vaginal birth after cesarean delivery in Japanese women. Int J Med Sci 2012; 9 (06) 488-491
    CrossrefPubMedGoogle Scholar
  • 7 Schoorel EN, Melman S, van Kuijk SM. , et al. 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. BJOG 2014; 121 (07) 840-847 , discussion 847
    CrossrefPubMedGoogle Scholar
  • 8 Fagerberg MC, Maršál K, Källén K. Predicting the chance of vaginal delivery after one cesarean section: validation and elaboration of a published prediction model. Eur J Obstet Gynecol Reprod Biol 2015; 188: 88-94
    CrossrefPubMedGoogle Scholar
  • 9 Metz TD, Allshouse AA, Faucett AM, Grobman WA. Validation of a vaginal birth after cesarean delivery prediction model in women with two prior cesarean deliveries. Obstet Gynecol 2015; 125 (04) 948-952
    CrossrefPubMedGoogle Scholar
  • 10 Landon MB, Leindecker S, Spong CY. , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. The MFMU Cesarean Registry: factors affecting the success of trial of labor after previous cesarean delivery. Am J Obstet Gynecol 2005; 193 (3 Pt 2): 1016-1023
    CrossrefPubMedGoogle Scholar
  • 11 National Institutes of Health Consensus Development Conference Panel. National Institutes of Health Consensus Development conference statement: vaginal birth after cesarean: new insights March 8-10, 2010. Obstet Gynecol 2010; 115 (06) 1279-1295
    CrossrefPubMedGoogle Scholar
  • 12 Yee LM, Liu LY, Grobman WA. Relationship between obstetricians' cognitive and affective traits and delivery outcomes among women with a prior cesarean. Am J Obstet Gynecol 2015; 213 (03) 413.e1-413.e7
    CrossrefPubMedGoogle Scholar
  • 13 Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol 2012; 120 (05) 1181-1193
    PubMedGoogle Scholar
  • 14 American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. Obstet Gynecol 2014; 123: 693-711
    CrossrefPubMedGoogle Scholar
  • 15 Grobman WA, Lai Y, Landon MB. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor?. Am J Obstet Gynecol 2009; 200 (01) 56.e1-56.e6
    CrossrefPubMedGoogle Scholar