External validation of a prediction model on vaginal birth after caesarean in a The Netherlands: a prospective cohort study
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Emy Vankan
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Sander M. J. van Kuijk
Abstract
Objectives
Discussing the individual probability of a successful vaginal birth after caesarean (VBAC) can support decision making. The aim of this study is to externally validate a prediction model for the probability of a VBAC in a Dutch population.
Methods
In this prospective cohort study in 12 Dutch hospitals, 586 women intending VBAC were included. Inclusion criteria were singleton pregnancies with a cephalic foetal presentation, delivery after 37 weeks and one previous caesarean section (CS) and preference for intending VBAC. The studied prediction model included six predictors: pre-pregnancy body mass index, previous vaginal delivery, previous CS because of non-progressive labour, Caucasian ethnicity, induction of current labour, and estimated foetal weight ≥90th percentile. The discriminative and predictive performance of the model was assessed using receiver operating characteristic curve analysis and calibration plots.
Results
The area under the curve was 0.73 (CI 0.69–0.78). The average predicted probability of a VBAC according to the prediction model was 70.3% (range 33–92%). The actual VBAC rate was 71.7%. The calibration plot shows some overestimation for low probabilities of VBAC and an underestimation of high probabilities.
Conclusions
The prediction model showed good performance and was externally validated in a Dutch population. Hence it can be implemented as part of counselling for mode of delivery in women choosing between intended VBAC or planned CS after previous CS.
Funding source: The Netherlands Organization for Health Research and Development (ZonMw)
Award Identifier / Grant number: 17100.3006
Acknowledgments
The author would like to thank all the patients who participated in our study.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: Ethical approval for this study was obtained from the Medical Ethical Committee of the Maastricht University Medical Centre+ (MUMC+) in The Netherlands (MEC number 12-4-091) (18-04-13).
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Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2020-0308).
© 2020 Walter de Gruyter GmbH, Berlin/Boston
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- Frontmatter
- Review
- Clinical evaluation of labor: an evidence- and experience-based approach
- Original Articles – Obstetrics
- How fever is defined in COVID-19 publications: a disturbing lack of precision
- Initial review of pregnancy and neonatal outcomes of pregnant women with COVID-19 infection
- Usefulness of COVID-19 screen-and-test approach in pregnant women: an experience from a country with low COVID-19 burden
- Clinical chorioamnionitis at term X: microbiology, clinical signs, placental pathology, and neonatal bacteremia – implications for clinical care
- Cytokine profiling: variation in immune modulation with preterm birth vs. uncomplicated term birth identifies pivotal signals in pathogenesis of preterm birth
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