| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
ORIGINAL RESEARCH |
From the Departments of Obstetrics and Gynecology at 1Northwestern University, Chicago, Illinois; 2the George Washington University Biostatistics Center, Washington, DC; 3the Ohio State University, Columbus, Ohio; 4National Institute of Child Health and Human Development, Bethesda, Maryland; 5University of Texas Southwestern Medical Center, Dallas, Texas; 6University of Alabama at Birmingham, Birmingham, Alabama; 7University of Chicago, Chicago, Illinois; 8University of Utah, Salt Lake City, Utah; 9University of Pittsburgh, Pittsburgh, Pennsylvania; 10Wake Forest University, Winston-Salem, North Carolina; 11Thomas Jefferson University, Philadelphia, Pennsylvania; 12Wayne State University, Detroit, Michigan; 13University of Cincinnati, Cincinnati, Ohio; 14Columbia University, New York, New York; 15Brown University, Providence, Rhode Island; 16University of Miami, Miami, Florida; 17University of Tennessee, Memphis, Tennessee; 18University of Texas at San Antonio, San Antonio, Texas; 19University of North Carolina, Chapel Hill, North Carolina; 20University of Texas at Houston, Houston, Texas; and 21Case Western Reserve University, Cleveland, Ohio.
OBJECTIVE: To develop a model based on factors available at the first prenatal visit that predicts chance of successful vaginal birth after cesarean delivery (VBAC) for individual patients who undergo a trial of labor.
METHODS: All women with one prior low transverse cesarean who underwent a trial of labor at term with a vertex singleton gestation were identified from a concurrently collected database of deliveries at 19 academic centers during a 4-year period. Using factors identifiable at the first prenatal visit, we analyzed different classification techniques in an effort to develop a meaningful prediction model for VBAC success. After development and cross-validation, this model was represented by a graphic nomogram.
RESULTS: Seven-thousand six hundred sixty women were available for analysis. The prediction model is based on a multivariable logistic regression, including the variables of maternal age, body mass index, ethnicity, prior vaginal delivery, the occurrence of a VBAC, and a potentially recurrent indication for the cesarean delivery. After analyzing the model with cross-validation techniques, it was found to be both accurate and discriminating.
CONCLUSION: A predictive nomogram, which incorporates six variables easily ascertainable at the first prenatal visit, has been developed that allows the determination of a patient-specific chance for successful VBAC for those women who undertake trial of labor.
LEVEL OF EVIDENCE: II
This article has been cited by other articles:
|
|
 |
|
  A. G. Cahill, D. M. Stamilio, A. O. Odibo, J. Peipert, E. Stevens, and G. A. Macones Racial Disparity in the Success and Complications of Vaginal Birth After Cesarean Delivery Obstet. Gynecol., March 1, 2008; 111(3): 654 - 658. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. M. Mercer, S. Gilbert, M. B. Landon, C. Y. Spong, K. J. Leveno, D. J. Rouse, M. W. Varner, A. H. Moawad, H. N. Simhan, M. Harper, et al. Labor Outcomes With Increasing Number of Prior Vaginal Births After Cesarean Delivery Obstet. Gynecol., February 1, 2008; 111(2): 285 - 291. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. R. Newton Vaginal Birth After Cesarean Prediction: A Self-Fulfilling Prophecy? Obstet. Gynecol., April 1, 2007; 109(4): 796 - 797. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
