TY - JOUR
T1 - Prognostic model on niche development after a first caesarean section
T2 - development and internal validation
AU - Stegwee, Sanne I.
AU - van der Voet, L. F.(Lucet)
AU - Heymans, Martijn W.
AU - Kapiteijn, Kitty
AU - van Laar, Judith O.E.H.
AU - van Baal, W. M.(Marchien)
AU - de Groot, Christianne J.M.
AU - Huirne, Judith A.F.
AU - Papatsonis, Dimitri N.M.
AU - Pajkrt, Eva
AU - Hehenkamp, Wouter J.K.
AU - Oei, Angèle L.M.
AU - Bekker, Mireille N.
AU - Schippers, Daniela H.
AU - van Vliet, Huib A.A.M.
AU - van der Voet, Lucet
AU - WE Schuitemaker, Nico
AU - Hemelaar, Majoie
AU - Huisjes, Anjoke J.M.
AU - Meijer, Wouter J.
AU - Janssen, C. A.H.(Ineke)
AU - Hermes, Wietske
AU - Feitsma, A. H.(Hanneke)
AU - van Eijndhoven, Hugo W.F.
AU - Rijnders, Robbert J.P.
AU - Sueters, Marieke
AU - Scheepers, H. C.J.(Liesbeth)
AU - Boormans, Elisabeth M.A.
AU - van Kesteren, Paul J.M.
AU - Radder, Celine M.
AU - Hink, Esther
AU - de Boer, Karin
AU - Kaplan, Mesrure
AU - van Beek, Erik
AU - de Vleeschouwer, L. H.M.(Marloes)
AU - Visser, Harry
AU - Langenveld, Josje
AU - 2Close study group
N1 - Funding Information:
This study used data of a study that was partly funded by ZonMw: The Netherlands Organisation for Health Research and Development (project number 843002605). The funding source had no involvement in the study design; in the collection, analysis, and interpretations of data; in the writing of the report; or in the decision to submit the article for publication.
Publisher Copyright:
© 2023 The Authors
PY - 2023/4/1
Y1 - 2023/4/1
N2 - Objective: To develop and internally validate a prognostic prediction model for development of a niche in the uterine scar after a first caesarean section (CS). Study design: Secondary analyses on data of a randomized controlled trial, performed in 32 hospitals in the Netherlands among women undergoing a first caesarean section. We used multivariable backward logistic regression. Missing data were handled using multiple imputation. Model performance was assessed by calibration and discrimination. Internal validation using bootstrapping techniques took place. The outcome was ‘development of a niche in the uterus’, defined as an indentation of = 2 mm in the myometrium. Results: We developed two models to predict niche development: in the total population and after elective CS. Patient related risk factors were: gestational age, twin pregnancy and smoking, and surgery related risk factors were double-layer closure and less surgical experience. Multiparity and Vicryl suture material were protective factors. The prediction model in women undergoing elective CS revealed similar results. After internal validation, Nagelkerke R2 ranged from 0.01 to 0.05 and was considered low; median area under the curve (AUC) ranged from 0.56 to 0.62, indicating failed to poor discriminative ability. Conclusions: The model cannot be used to accurately predict the development of a niche after a first CS. However, several factors seem to influence scar healing which indicates possibilities for future prevention such as surgical experience and suture material. The search for additional risk factors that play a role in development of a niche should be continued to improve the discriminative ability.
AB - Objective: To develop and internally validate a prognostic prediction model for development of a niche in the uterine scar after a first caesarean section (CS). Study design: Secondary analyses on data of a randomized controlled trial, performed in 32 hospitals in the Netherlands among women undergoing a first caesarean section. We used multivariable backward logistic regression. Missing data were handled using multiple imputation. Model performance was assessed by calibration and discrimination. Internal validation using bootstrapping techniques took place. The outcome was ‘development of a niche in the uterus’, defined as an indentation of = 2 mm in the myometrium. Results: We developed two models to predict niche development: in the total population and after elective CS. Patient related risk factors were: gestational age, twin pregnancy and smoking, and surgery related risk factors were double-layer closure and less surgical experience. Multiparity and Vicryl suture material were protective factors. The prediction model in women undergoing elective CS revealed similar results. After internal validation, Nagelkerke R2 ranged from 0.01 to 0.05 and was considered low; median area under the curve (AUC) ranged from 0.56 to 0.62, indicating failed to poor discriminative ability. Conclusions: The model cannot be used to accurately predict the development of a niche after a first CS. However, several factors seem to influence scar healing which indicates possibilities for future prevention such as surgical experience and suture material. The search for additional risk factors that play a role in development of a niche should be continued to improve the discriminative ability.
KW - Caesarean section
KW - Niche development
KW - Residual myometrium thickness
KW - Risk factors
KW - Transvaginal ultrasound
U2 - 10.1016/j.ejogrb.2023.01.014
DO - 10.1016/j.ejogrb.2023.01.014
M3 - Article
C2 - 36796129
SN - 0301-2115
VL - 283
SP - 59
EP - 67
JO - European Journal of Obstetrics & Gynecology and Reproductive Biology
JF - European Journal of Obstetrics & Gynecology and Reproductive Biology
IS - 1
ER -