A clinical prediction model to assess the risk of operative delivery

BJOG : an International Journal of Obstetrics and Gynaecology
E SchuitR H H Groenwold

Abstract

To predict instrumental vaginal delivery or caesarean section for suspected fetal distress or failure to progress. Secondary analysis of a randomised trial. Three academic and six non-academic teaching hospitals in the Netherlands. 5667 labouring women with a singleton term pregnancy in cephalic presentation. We developed multinomial prediction models to assess the risk of operative delivery using both antepartum (model 1) and antepartum plus intrapartum characteristics (model 2). The models were validated by bootstrapping techniques and adjusted for overfitting. Predictive performance was assessed by calibration and discrimination (area under the receiver operating characteristic), and easy-to-use nomograms were developed. Incidence of instrumental vaginal delivery or caesarean section for fetal distress or failure to progress with respect to a spontaneous vaginal delivery (reference). 375 (6.6%) and 212 (3.6%) women had an instrumental vaginal delivery or caesarean section due to fetal distress, and 433 (7.6%) and 571 (10.1%) due to failure to progress, respectively. Predictors were age, parity, previous caesarean section, diabetes, gestational age, gender, estimated birthweight (model 1) and induction of labour, oxytocin aug...Continue Reading

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