Examining the validity of a predictive model for vaginal birth after cesarean
-
Jennifer W.H. Wong
,
Kurt D.N. Yoshino
Abstract
Background
The Maternal-Fetal Medicine Units (MFMU) vaginal birth after cesarean (VBAC) calculator, while accurate for candidates with high predicted success rates, is not as accurate for poor candidates. This study examines the calculator’s validity in an understudied multiracial cohort with a high proportion of poor candidates.
Methods
This retrospective study examined women with one or two prior cesarean deliveries who attempted VBAC at a single institution. Subjects were placed into quartiles based on MFMU-predicted success rates. For each quartile, actual and predicted success rates were compared. The calculated area under the receiver operating characteristic curve (AUC) was compared to the original AUC.
Results
The study included 1604 women. Actual and predicted VBAC rates were similar in the lowest and highest quartile groups, 18.2% vs. 21.2% (n = 11, P > 0.99) and 87.1% vs. 88.5% (n = 1090, P = 0.14), respectively. In the 51–75% predicted success rate group, the actual VBAC rate was higher than the predicted rate, 69.9% vs. 65.5% (n = 394) but not statistically significant (P = 0.07). In the 25–50% predicted success rate group, the actual VBAC rate was significantly higher than the predicted rate 55.1% vs. 39.6% (n = 109, P = 0.002). The actual AUC was lower than the MFMU model, 0.72 [95% confidence interval (CI) 0.69–0.75] vs. 0.77 (95% CI 0.76–0.78) (P < 0.001).
Conclusion
The MFMU VBAC calculator’s predicted success rates were comparable to actual success rates for candidates with predicted success rates >75%. As predicted success rates declined, the calculator was increasingly inaccurate and underestimated the success rate. Caution should be taken when using the MFMU VBAC calculator for poor candidates.
Funding source: National Institutes of Health
Award Identifier / Grant number: U54MD007601
Award Identifier / Grant number: U54MD007584
Award Identifier / Grant number: 2U54GM104944
Funding statement: This study was funded by the Lakshmi Devi and Devraj Sharma Endowment. Dr. Hyeong Jun Ahn and Ms. So Yung Choi were partially supported by the National Institutes of Health under Funder Id: http://dx.doi.org/10.13039/100000002, grants U54MD007601, U54MD007584, and 2U54GM104944.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication. The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institutes of Health.
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©2020 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- 10.1515/jpm-2020-frontmatter1
- Review
- Delivery room handling of the newborn
- Original Articles – Obstetrics
- Examining the validity of a predictive model for vaginal birth after cesarean
- Correlation between endometrial thickness and perinatal outcome for pregnancies achieved through assisted reproduction technology
- Significance of the routine first-trimester antenatal screening program for aneuploidy in the assessment of the risk of placenta accreta spectrum disorders
- A decade’s experience in primipara, term, singleton, vertex parturients with a sustained low rate of CD
- Survey of alongside midwifery-led care in North Rhine-Westfalia, Germany
- Correlation between aneuploidy pregnancy and the concentration of various hormones and vascular endothelial factor in follicular fluid as well as the number of acquired oocytes
- Bacteriuria in pregnancy varies with the ambiance: a retrospective observational study at a tertiary hospital in Doha, Qatar
- Microarray findings in pregnancies with oligohydramnios – a retrospective cohort study and literature review
- Lifestyle characteristics of parental electronic cigarette and marijuana users: healthy or not?
- Influence of maternal HIV infection on fetal thymus size
- Original Articles – Fetus
- Clinical outcome of prenatally suspected cardiac rhabdomyomas of the fetus
- Original Articles – Newborns
- Prolonged ventilation and postnatal growth of preterm infants
- Letter to the Editor
- Neonatal sepsis associated with Lactobacillus supplementation
Artikel in diesem Heft
- 10.1515/jpm-2020-frontmatter1
- Review
- Delivery room handling of the newborn
- Original Articles – Obstetrics
- Examining the validity of a predictive model for vaginal birth after cesarean
- Correlation between endometrial thickness and perinatal outcome for pregnancies achieved through assisted reproduction technology
- Significance of the routine first-trimester antenatal screening program for aneuploidy in the assessment of the risk of placenta accreta spectrum disorders
- A decade’s experience in primipara, term, singleton, vertex parturients with a sustained low rate of CD
- Survey of alongside midwifery-led care in North Rhine-Westfalia, Germany
- Correlation between aneuploidy pregnancy and the concentration of various hormones and vascular endothelial factor in follicular fluid as well as the number of acquired oocytes
- Bacteriuria in pregnancy varies with the ambiance: a retrospective observational study at a tertiary hospital in Doha, Qatar
- Microarray findings in pregnancies with oligohydramnios – a retrospective cohort study and literature review
- Lifestyle characteristics of parental electronic cigarette and marijuana users: healthy or not?
- Influence of maternal HIV infection on fetal thymus size
- Original Articles – Fetus
- Clinical outcome of prenatally suspected cardiac rhabdomyomas of the fetus
- Original Articles – Newborns
- Prolonged ventilation and postnatal growth of preterm infants
- Letter to the Editor
- Neonatal sepsis associated with Lactobacillus supplementation
