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Am J Perinatol 2013; 30(10): 827-832
DOI: 10.1055/s-0032-1333411
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Predicting Cesarean in the Second Stage of Labor

Lorie M. Harper
1   Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama
,
Anthony O. Odibo
2   Department of Obstetrics and Gynecology, Washington University in St. Louis, St Louis, Missouri
,
George A. Macones
2   Department of Obstetrics and Gynecology, Washington University in St. Louis, St Louis, Missouri
,
Alison G. Cahill
2   Department of Obstetrics and Gynecology, Washington University in St. Louis, St Louis, Missouri
› Author Affiliations
Further Information

Publication History

01 November 2012

13 November 2012

Publication Date:
17 January 2013 (online)

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Abstract

Objective To develop a prediction model for cesarean delivery (CD) in the second stage of labor using classification and regression tree (CART) analysis.

Study Design Retrospective cohort of term women who reached 10-cm dilation. The primary outcome was CD at 10-cm dilation. Logistic regression and CART analysis were performed to identify factors that best predict second-stage CD. Only factors known at the time a patient reaches 10-cm dilation were used.

Results Of 5,388 subjects who reached 10 cm, 88 (1.6%) underwent CD. The logistic regression model identified 4 risk factors for CD and produced an area under the receiver operator characteristic curve of 0.75 (95% confidence interval 0.70 to 0.81). CART analysis identified the most important variable in predicting second-stage CD was a station at or higher than 0 at complete dilatation, but correctly classified only 19.3% of CD.

Conclusion Second-stage cesarean cannot be reliably predicted based on antenatal and intrapartum characteristics by logistic regression or CART techniques.

Keywords

cesarean delivery - second stage of labor - CART - prediction model

Presentations

This abstract was presented at the Society for Maternal Fetal Medicine, February 6 to 11, 2012, Dallas, Texas.


This study was conducted in Washington University in St. Louis, Missouri.


 

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