Externally Validated Score to Predict Cesarean Delivery After Labor Induction With Cervical Ripening (original) (raw)
Related papers
Validation of models that predict Cesarean section after induction of labor
Ultrasound in Obstetrics and Gynecology, 2009
Objective Models for the prediction of Cesarean delivery after induction of labor can be used to improve clinical decision-making. The objective of this study was to validate two existing models, published by Peregrine et al. and Rane et al., for the prediction of Cesarean section after induction of labor. Methods We studied consecutive women in whom labor was induced. In all women, we recorded maternal age, height, body mass index, parity, gestational age and the Bishop score prior to induction. Cervical length was measured by transvaginal ultrasound immediately prior to induction of labor. The primary end-point was delivery by Cesarean section. The calibration of the two prediction models was assessed by comparison of predicted and observed Cesarean delivery rates. The discriminative capacity of the models, i.e. the ability of the models to distinguish subjects who had Cesarean section from those who did not (discrimination), was assessed by receiver-operating characteristics (ROC) analysis. Results We included 240 women in the study, of whom 27 (11%) had Cesarean delivery. The capacity of cervical length in the prediction of Cesarean delivery was limited. In our study population, both prediction models overestimated the risk of Cesarean delivery. Calibration was better for the Peregrine et al. model than for the Rane et al. model, and the two models had areas under the ROC curve of 0.76 and 0.67, respectively. Conclusion Current models that predict the occurrence of Cesarean section after induction of labor have only a moderate predictive capacity when applied within a Dutch practice. We do not recommend the use of these prediction models in clinical practice.
Ultrasound in Obstetrics & Gynecology, 2005
ObjectiveTo develop a clinically useful tool to predict the probability of preterm delivery in patients with threatened preterm labor.MethodsOne hundred and seventy patients with preterm labor between 24 and 34 weeks of gestation were included. Preterm delivery < 37 weeks of gestation was the main endpoint of the study. The data were randomized and split into an evaluation set (n = 85) and a validation set (n = 85). The evaluation set was subjected to stepwise backward logistic regression analysis to quantify the relative impact of four potential risk factors, including individual patient factors, results of a rapid fetal fibronectin assay, and sonographic measurement of cervical length. Using the constant of the logistic regression analysis and the beta‐coefficients for the identified risk factors the individual probability of preterm delivery for each woman of the validation dataset was calculated. The area under a receiver–operating characteristics curve (AUC) was used to eval...
Obstetrical & Gynecological Survey, 2013
section face the decision either to undergo an elective repeat Caesarean section (ERCS) or to attempt a trial of labour with the goal of achieving a vaginal birth after Caesarean (VBAC) Both choices are associated with their own risks of maternal and neonatal morbidity We aimed to determine the external validity of a prediction model for the success of trial of labour after Caesarean section (TOLAC) that could help these women in their decision-making
Induction of labor is conducted in special fetal or maternal conditions. Labor is induced in about 20% of women. The aim of this study was realizing the relationship between some factors including cervical ripening and also response to induction so we could predict the induction outcome better. Material and methods: The present prospective study was based on 101 pregnancy cases admitted to the labor ward in Urmia from March 2010 until December 2010. Maternal age ranged from 17 to 41 years and the gestational age between 37 to 42 weeks according to an ultrasound or reliable last menstrual period, as criteria of study inclusion. After admission, patients had a vaginal speculum for Preterm Premature Rupture of Membranes (PPROM), Abdominal ultrasonography for biometry and Amniotic Fluid Index (AFI), transperineal ultrasonography for measuring fetal head distance to maternal perineum, and vaginal ultrasonography for measuring cervical length and posterior angle of fetal head with cervix were undergone. Bishop score was assigned to another person. Labor was induced by administering either intravaginal misoprostol (25 microgram every six hours for a Bishop score lower than 7) or intravenous oxytocin (low dose regimen for a Bishop score equal to or more than 7). Results: Misoprostol was used for 75 patients and 26 patients had induction of labor with low dose oxytocin. Eighty one patients had Normal Vaginal Delivery (NVD) while 20 were delivered via Cesarean Section. For cervical ripening, Bishop Score (p<0.001), cervical length (p=0.04) and parity (p=0.06) were predicting factors. The cervical posterior angle p=0.02 had a predicting role in natural delivery. Conclusion: The cervical posterior angle was a predicting factor for natural delivery. Although cervical length, Body Mass Index (BMI), and parity were not predicting factors for natural delivery; these factors were good predictors for cervical ripening.
Archives of Gynecology and Obstetrics, 2016
Purpose To develop a risk-assessment model for the prediction of emergency cesarean section (CS) in women having induction of labor (IOL). Methods This was an observational cohort study of women with IOL for any indication between 2007 and 2013. Women induced for stillbirths and with multiple pregnancies were excluded. The primary objective was to identify risk factors associated with CS delivery and to construct a risk-prediction tool. Results 6169 women were identified with mean age of 28.9 years. Primiparity involved 47.1 %, CS rate was 13.3 % and postdate pregnancies were 32.4 %. Risk factors for CS were: age [30 years, BMI [25 kg/m 2 , primiparity, black-ethnicity, non postdate pregnancy, meconium-stained liquor, epidural analgesia, and male fetal gender. Each factor was assigned a score and with increasing scores the CS rate increased. The CS rate was 5.4 % for a score\11, while for a score C11 it increased to 25.0 %. The model had a sensitivity, specificity, negative predictive value and positive predictive value of 75.8, 65.1, 93.8 and 25.0 %, respectively. Conclusion We have constructed a risk-prediction tool for CS delivery in women with IOL. The risk-assessment tool for the prediction of emergency CS in induced labor has a high negative-predictive value and can provide reassurance to presumed low-risk women.
Acta Obstetricia et Gynecologica Scandinavica, 2019
Introduction: Great variations in cesarean rates after induction of labor exist and reasons for these disparities remain unclear. They may be explained by individual characteristics or obstetric practices. Ten-group classification systems have proved their utility to monitor cesarean rates in general population. We aimed to identify groups of women that account for most cesareans after induction of labor using the Nippita reproducible ten-group classification, specifically designed for induced population. Material and methods: A prospective population-based cohort study was performed in 94 French maternity units, including 3042 women undergoing induction of labor. Women were sorted according to ten mutually exclusive group based on parity, weeks of gestation, number of fetuses, fetal presentation, and previous cesarean delivery. Relative size, cesarean delivery rate and contribution to the overall cesarean rate were described for each group. Cesarean rates were compared according to the Bishop score at the onset of labor induction. Indications for cesarean delivery were also described in the groups that most contributed to the overall cesarean rate. The MEDIP protocol was registered in ClinicalTrial (NCT02477085). Results: The overall cesarean rate was 21.0% among this population of induced women. Nulliparous women with a term singleton cephalic fetus (groups 1, 2, and 3; at 37-38 weeks of gestation, 39-40 weeks of gestation and ≥ 41 weeks of gestation, respectively) accounted for twothirds of the overall cesarean rate, because they were the largest group (10.6%, 16.6%, and 18.1%, respectively) and had higher cesarean rates (27.2%, 30.9%, and 33.0%, respectively). When the Bishop score was < 6 (N=2270/3042), cesarean delivery rates were higher (24.1% vs 10.7% if Bishop score ≥6, P<0.01), in particular for group 1 (29.1 vs 12.5%, P=0.02), and group 2 (33.3 vs 19.3%, P=0.01). In group 1, 2 and 3 that most contributed to the overall cesarean rate, a significant part of the cesareans were performed before 6 cm of cervical dilatation for dystocia only (40.0%, 16.7%, and 17.6%, respectively). Conclusions: Nulliparous women with a term singleton cephalic fetus and an unfavorable cervix represent the population to target for auditing induction practices. Specific actions could be implemented among this population to weigh the benefits and risks of induction and improve the management of labor induction.
Paediatric and Perinatal Epidemiology, 2019
Background: There is no consensus about the ideal cervical ripening method to use for induction of labour. Objective: To compare in current practice the effectiveness and safety of four cervical ripening methods. Methods: We performed a matched comparative study using data from the MEDIP prospective population-based cohort conducted during one month in 2015 in all maternity units of seven French perinatal networks (3042 consecutive women with a live fetus and induction of labour). We analysed 1671 women with singleton cephalic fetus, unscarred uterus, and bishop score <7. Dinoprostone vaginal pessary (reference) was compared to dinoprostone vaginal gel, misoprostol vaginal tablet, and balloon catheter. Effectiveness outcomes were the need for more than one induction agent, oxytocin use, failure to achieve vaginal delivery within 24 hours (VD < 24 hours), and caesarean delivery. Safety outcomes were meconium-stained amniotic fluid, uterine hyperstimulation, NICU admission, and post-partum haemorrhage. Coarsened exact matching was used to balance confounders among the groups. Outcomes were compared using multivariable logistic regression models. Results: Compared to the dinoprostone pessary (N = 1142, 68.3%), dinoprostone gel (N = 335, 20.1%) was associated with less failure to achieve VD < 24 hours (adjusted OR 0.66, 95% CI 0.47, 0.91). Misoprostol (N = 103, 6.2%) was associated with less need of more than one induction agent (aOR 0.56, 95% CI 0.34, 0.92) and less oxytocin use (aOR 0.60, 95% CI 0.37, 0.99). The balloon catheter (N = 91, 5.4%) was associated with more failure to achieve VD < 24 hours (aOR 2.62, 95% CI 1.37, 5.01), more caesarean delivery (aOR 1.84, 95% CI 1.09, 3.08), and less meconium-stained amniotic fluid (aOR 0.12, 95% CI 0.02, 0.70). Uterine hyperstimulation rates seemed lower with the balloon catheter (1.2% vs 4.2% for the pessary). Conclusions: In current practice, no cervical ripening method appears clearly superior to the others considering all effectiveness and safety outcomes.
Journal of South Asian Federation of Obstetrics and Gynaecology
Aims and objectives: To assess the prediction of a successful trial of labor after cesarean section (TOLAC) using a predictive scoring system at the time of labor. Materials and methods: The present study was a prospective cohort study. Women with one previous lower segment cesarean section (LSCS) in labor admitted to the labor room, willing for a vaginal birth after cesarean section (VBAC) were included in the study and explained about the option of TOLAC with the predictive score (integer score) and its success. The predictive validity of the VBAC score was assessed by the receiver operating curve (ROC) analysis. Results: A total of 194 women were included in the study. The proportion of successful VBAC was 43.30% in the current study. The most common indication for previous LSCS in the patients who underwent repeat LSCS was nonprogress of labor (17.53%) followed by fetal distress in 12.89%. The VBAC score had good predictive validity in predicting successful VBAC, as indicated by the area under the curve of 0.853 (95% CI 0.798 to 0.908, p value < 0.001). The sensitivity of a VBAC score of 13.5 or more in predicting successful VBAC was 83.3% (95 CI 75.36% to 91.3%) and specificity was 78.2% (95 CI 70.46% to 85.9%). Positive predictive value was 74.5% (95 CI 65.65% to 83.3%), negative predictive value was 86% (95 CI 79.2% to 92.8%), and the total diagnostic accuracy was 80.4% (95 CI 74.83% to 86%). After controlling the effect of other values in the equation, the history of previous vaginal birth and high modified Bishop score were the factors that were significantly associated with successful VBAC. The symptomatic uterine rupture occurred in 0.1% of women who underwent TOLAC. No perinatal morbidity or mortality is seen. Conclusion: Vaginal birth after cesarean section score has demonstrated as a good predictive validity in predicting successful VBAC. TOLAC should be encouraged in most of the women who are willing to attempt it, provided no obstetric contraindication exists.
2022
Background: To develop a predictive model for successfully inducing active labor by using a combination of cervical status and maternal and fetal characteristics. Methods: A retrospective cohort study was conducted among pregnant women who underwent labor induction between January 2015 and December 2019. Successfully inducing active labor was de ned as achieving a cervical dilation >4 cm within 10 hours after adequate uterine contractions. The medical data were extracted from the hospital database; statistical analyses were performed using R software, and a logistic regression model was used to identify the predictors associated with the successful induction of labor. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to assess the accuracy of the model. Results: In total, 1448 pregnant women were enrolled; 960 (66.3%) achieved successful induction of active labor. Multivariate analysis revealed that maternal age, parity, body mass index, oligohydramnios, premature rupture of membrane, fetal sex, dilatation, station, and consistency were signi cant factors associated with successful labor induction. The ROC curve of the logistic regression model had an AUC of 0.7728. For the validated score system to predict probability of success, we found that a total score > 60 has 73.0 % (95% CI 59.0-83.5) probability of successful induction of labor into the active phase stage within 10 hours. Conclusions: The predictive model for successfully achieving active labor using the combination of cervical status and maternal and fetal characteristics had good predictive ability and was easy to use in clinical practice.