TY - JOUR
T1 - Current predictors for morbidity regarding choice of birth after a previous caesarean section, show poor predictive value in prediction modelling
AU - van Hees, Merel S.F.
AU - van Kuijk, Sander M.J.
AU - Koppes, Dorothea M.
AU - Oudijk, Martijn A.
AU - Vankan, Emy
AU - Smits, Luc J.
AU - Scheepers, Hubertina C.J.
N1 - Funding Information:
We would like to thank all participation hospitals, medical doctors and research nurses of the SIMPLE-studies. Merel S.F. van Hees: conception and design, analysis and interpretation of the data, drafting and revising the article. Sander M.J. van Kuijk: conception and design, analysis and interpretation of the data, revising the article. Dorothea M. Koppes, Martijn A. Oudijk, Emy Vankan: acquisition of the data and revising the article. Luc J. Smits: interpretation of the data and revising the article. Hubertina C.J. Scheepers: Conception and design, interpretation of the data, drafting and revising the article. All authors gave their final approval of the version to be published and agreement to be accountable for all aspects of the work. For the previous SIMPLE-studies ethical approval was obtained, by the Medical Ethical Committee of the MUMC+ (Maastricht University Medical Centre). For this research, previous collected data was used, there for renewed ethical approval was not obtained. The original data used in this research, were collected on a grand provided by ZONMW (The Dutch organization for healthcare research and innovation). ZonMW had no interference in the publication process.
Publisher Copyright:
© 2024
PY - 2024/12/1
Y1 - 2024/12/1
N2 - Introduction: After a previous caesarean section, morbidity in the subsequent delivery in general is considered to depend on the probability of a vaginal birth after caesarean. However counselling could be improved by adding individualized probability of serious morbidity following either trial of labour or elective repeat caesarean section. The objective of this study was to develop prediction models for morbidity for both a repeat caesarean section and a trial of labor for a Dutch population. Material and methods: In this cohort study, data were joined from three previous studies (SIMPLE 1, SIMPLE 2 and SIMPLE 2-implementation study). A cohort of 2592 women with one previous caesarean section and a singleton pregnancy who delivered =37 weeks, without a contraindication for vaginal delivery was formed. Maternal morbidity was defined as postpartum hemorrhage, blood transfusion, uterine rupture, ICU admittance or death. Neonatal morbidity was defined as asphyxia, NICU-admittance or death. Potential predictors for morbidity were chosen based on literature and expert opinion. Logistic regression was used to develop the models. Internal validation was intended using bootstrapping techniques. Main outcome measures were predictors for morbidity and for validation of the model we used the area under the receiver operating characteristic curve for discriminative capacity and calibration for accuracy. Results: In 324 out of the 2592 cases (12.7 %) maternal or fetal complications occurred. In general total morbidity was higher in women choosing TOL as compared to ERCS (p < 0.001). The performance of the several developed models was insufficient, the area under the receiver operating characteristic curve did not rise above 0.6. Due to poor model performance, before correction for overfitting, interval validation was not conducted. Conclusion: In this large cohort, developing a Dutch population based prediction model that aimed to improve counselling on the mode of delivery, by predicting individual chances of morbidity for different delivery modes was not possible, due to lack of performance. Further study could be directed to cut off on VBAC success rates to a more general advice regarding the safest mode of delivery.
AB - Introduction: After a previous caesarean section, morbidity in the subsequent delivery in general is considered to depend on the probability of a vaginal birth after caesarean. However counselling could be improved by adding individualized probability of serious morbidity following either trial of labour or elective repeat caesarean section. The objective of this study was to develop prediction models for morbidity for both a repeat caesarean section and a trial of labor for a Dutch population. Material and methods: In this cohort study, data were joined from three previous studies (SIMPLE 1, SIMPLE 2 and SIMPLE 2-implementation study). A cohort of 2592 women with one previous caesarean section and a singleton pregnancy who delivered =37 weeks, without a contraindication for vaginal delivery was formed. Maternal morbidity was defined as postpartum hemorrhage, blood transfusion, uterine rupture, ICU admittance or death. Neonatal morbidity was defined as asphyxia, NICU-admittance or death. Potential predictors for morbidity were chosen based on literature and expert opinion. Logistic regression was used to develop the models. Internal validation was intended using bootstrapping techniques. Main outcome measures were predictors for morbidity and for validation of the model we used the area under the receiver operating characteristic curve for discriminative capacity and calibration for accuracy. Results: In 324 out of the 2592 cases (12.7 %) maternal or fetal complications occurred. In general total morbidity was higher in women choosing TOL as compared to ERCS (p < 0.001). The performance of the several developed models was insufficient, the area under the receiver operating characteristic curve did not rise above 0.6. Due to poor model performance, before correction for overfitting, interval validation was not conducted. Conclusion: In this large cohort, developing a Dutch population based prediction model that aimed to improve counselling on the mode of delivery, by predicting individual chances of morbidity for different delivery modes was not possible, due to lack of performance. Further study could be directed to cut off on VBAC success rates to a more general advice regarding the safest mode of delivery.
KW - Morbidity
KW - Prediction model
KW - Probability
KW - Trial of labor
KW - Vaginal birth after caesarean
U2 - 10.1016/j.ejogrb.2024.10.018
DO - 10.1016/j.ejogrb.2024.10.018
M3 - Article
SN - 0301-2115
VL - 303
SP - 57
EP - 62
JO - European Journal of Obstetrics & Gynecology and Reproductive Biology
JF - European Journal of Obstetrics & Gynecology and Reproductive Biology
ER -