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Predicting vaginal birth after cesarean section: a cohort study. 2014

Jennifer A Tessmer-Tuck, and Sherif A El-Nashar, and Adrianne R Racek, and Christine M Lohse, and Abimbola O Famuyide, and Myra J Wick
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn., USA.

OBJECTIVE To develop a model to predict vaginal birth after cesarean (VBAC) in our population and to compare the accuracy of this model to the accuracy of a previously published widely used model. METHODS Women attempting trial of labor after cesarean delivery (TOLAC) at our institution from January 1, 2000 through May 30, 2010 were evaluated for inclusion. Demographic and clinical data were collected. Associations of these characteristics with VBAC were evaluated with univariate and multivariate logistic regression. We critically compared the accuracy of the resulting model to a previously published widely utilized model for predicting VBAC. RESULTS A total of 2,635 deliveries with at least 1 prior cesarean delivery were identified. TOLAC was attempted in 599 (22.7%) and resulted in 456 VBACs (76.0%) and 143 repeat cesareans (24.0%). VBAC success was independently associated with age <30 years, a body mass index <30, prior vaginal delivery, prior VBAC, and absence of a recurrent indication for cesarean. This model provided a range of successful probability of VBAC (38-98%) with an area under the receiver operating characteristic curve of 0.723. CONCLUSIONS This study provides an accurate and simple model that can be utilized to guide decisions related to TOLAC.

UI MeSH Term Description Entries
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D012372 ROC Curve A graphic means for assessing the ability of a screening test to discriminate between healthy and diseased persons; may also be used in other studies, e.g., distinguishing stimuli responses as to a faint stimuli or nonstimuli. ROC Analysis,Receiver Operating Characteristic,Analysis, ROC,Analyses, ROC,Characteristic, Receiver Operating,Characteristics, Receiver Operating,Curve, ROC,Curves, ROC,ROC Analyses,ROC Curves,Receiver Operating Characteristics
D014219 Trial of Labor Allowing a woman to be in LABOR, OBSTETRIC long enough to determine if vaginal birth may be anticipated. Labor Trial,Labor Trials
D015233 Models, Statistical Statistical formulations or analyses which, when applied to data and found to fit the data, are then used to verify the assumptions and parameters used in the analysis. Examples of statistical models are the linear model, binomial model, polynomial model, two-parameter model, etc. Probabilistic Models,Statistical Models,Two-Parameter Models,Model, Statistical,Models, Binomial,Models, Polynomial,Statistical Model,Binomial Model,Binomial Models,Model, Binomial,Model, Polynomial,Model, Probabilistic,Model, Two-Parameter,Models, Probabilistic,Models, Two-Parameter,Polynomial Model,Polynomial Models,Probabilistic Model,Two Parameter Models,Two-Parameter Model
D015331 Cohort Studies Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. Birth Cohort Studies,Birth Cohort Study,Closed Cohort Studies,Cohort Analysis,Concurrent Studies,Historical Cohort Studies,Incidence Studies,Analysis, Cohort,Cohort Studies, Closed,Cohort Studies, Historical,Studies, Closed Cohort,Studies, Concurrent,Studies, Historical Cohort,Analyses, Cohort,Closed Cohort Study,Cohort Analyses,Cohort Studies, Birth,Cohort Study,Cohort Study, Birth,Cohort Study, Closed,Cohort Study, Historical,Concurrent Study,Historical Cohort Study,Incidence Study,Studies, Birth Cohort,Studies, Cohort,Studies, Incidence,Study, Birth Cohort,Study, Closed Cohort,Study, Cohort,Study, Concurrent,Study, Historical Cohort,Study, Incidence

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