A clinical prediction model to assess the risk of operative delivery
Article first published online: 9 MAY 2012
© 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 119, Issue 8, pages 915–923, July 2012
How to Cite
Schuit, E., Kwee, A., Westerhuis, M., Van Dessel, H., Graziosi, G., Van Lith, J., Nijhuis, J., Oei, S., Oosterbaan, H., Schuitemaker, N., Wouters, M., Visser, G., Mol, B., Moons, K. and Groenwold, R. (2012), A clinical prediction model to assess the risk of operative delivery. BJOG: An International Journal of Obstetrics & Gynaecology, 119: 915–923. doi: 10.1111/j.1471-0528.2012.03334.x
- Issue published online: 17 JUN 2012
- Article first published online: 9 MAY 2012
- Accepted 8 March 2012. Published Online 9 May 2012.
- Caesarean section;
- failure to progress;
- instrumental vaginal delivery;
- prognostic model;
- suspected fetal distress
Please cite this paper as: Schuit E, Kwee A, Westerhuis M, Van Dessel H, Graziosi G, Van Lith J, Nijhuis J, Oei S, Oosterbaan H, Schuitemaker N, Wouters M, Visser G, Mol B, Moons K, Groenwold R. A clinical prediction model to assess the risk of operative delivery. BJOG 2012;119:915–923.
Objective To predict instrumental vaginal delivery or caesarean section for suspected fetal distress or failure to progress.
Design Secondary analysis of a randomised trial.
Setting Three academic and six non-academic teaching hospitals in the Netherlands.
Population 5667 labouring women with a singleton term pregnancy in cephalic presentation.
Methods We developed multinomial prediction models to assess the risk of operative delivery using both antepartum (model 1) and antepartum plus intrapartum characteristics (model 2). The models were validated by bootstrapping techniques and adjusted for overfitting. Predictive performance was assessed by calibration and discrimination (area under the receiver operating characteristic), and easy-to-use nomograms were developed.
Main outcome measures Incidence of instrumental vaginal delivery or caesarean section for fetal distress or failure to progress with respect to a spontaneous vaginal delivery (reference).
Results 375 (6.6%) and 212 (3.6%) women had an instrumental vaginal delivery or caesarean section due to fetal distress, and 433 (7.6%) and 571 (10.1%) due to failure to progress, respectively. Predictors were age, parity, previous caesarean section, diabetes, gestational age, gender, estimated birthweight (model 1) and induction of labour, oxytocin augmentation, intrapartum fever, prolonged rupture of membranes, meconium stained amniotic fluid, epidural anaesthesia, and use of ST-analysis (model 2). Both models showed excellent calibration and the receiver operating characteristics areas were 0.70–0.78 and 0.73–0.81, respectively.
Conclusion In Dutch women with a singleton term pregnancy in cephalic presentation, antepartum and intrapartum characteristics can assist in the prediction of the need for an instrumental vaginal delivery or caesarean section for fetal distress or failure to progress.