Predicting successful intended vaginal delivery after previous caesarean section: external validation of two predictive models in a Dutch nationwide registration-based cohort with a high intended vaginal delivery rate
Predicting successful intended vaginal delivery after previous caesarean section: external validation of two predictive models in a Dutch nationwide registration-based cohort with a high intended vaginal delivery rate
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DOI：
10.1111/1471-0528.12605
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发表时间：
2014-06-01
影响因子：
5.8
通讯作者：
Scheepers, H. C. J.
中科院分区：
文献类型：
--
作者：
Schoorel, E. N. C.;Melman, S.;Scheepers, H. C. J.
目的外部验证来自美国的两个模型（入院护理[ETC]和临产[CTD]），预测荷兰人群剖腹产后成功预期阴道分娩（VBAC）。设计一项全国性的基于登记的队列研究。设置十七家医院荷兰。人口七百六十三名孕妇，每一个都有一个先前的剖腹产和一个可行的单胎头侧妊娠，没有预期的VBAC的禁忌症。方法ETC模型包括变量产妇年龄，孕前体重指数（BMI），种族、既往阴道分娩、既往VBAC和既往非进行性分娩。CTD模型用孕晚期BMI取代了孕前BMI，并增加了分娩时的估计胎龄、妊娠期高血压疾病、宫颈检查和引产。我们纳入了2010年分娩的符合条件的妇女的连续医疗记录。为了验证，个人概率的妇女谁有一个预期的VBAC counted.Main结果measuresDiscriminative性能进行了评估与曲线下面积（AUC）的受试者工作特性和预测性能进行了评估与校准图和Hosmer-Lemeshow（H-L）statistics.Results5015（67%）的763名妇女有一个预期的VBAC;其中72%（371）有实际的VBAC。ETC和CTD模型的AUC分别为68%（95% CI 63-72%）和72%（95% CI 67-76%）。H-L统计显示，P值为0.167的ETC模型和P=0.356的CTD模型，表明没有缺乏fit.ConclusionExternal验证的两个预测模型在美国开发的荷兰人口内显示了足够的性能。
ObjectiveTo externally validate two models from the USA (entry-to-care [ETC] and close-to-delivery [CTD]) that predict successful intended vaginal birth after caesarean (VBAC) for the Dutch population.DesignA nationwide registration-based cohort study.SettingSeventeen hospitals in the Netherlands.PopulationSeven hundred and sixty-three pregnant women, each with one previous caesarean section and a viable singleton cephalic pregnancy without a contraindication for an intended VBAC.MethodsThe ETC model comprises the variables maternal age, prepregnancy body mass index (BMI), ethnicity, previous vaginal delivery, previous VBAC and previous nonprogressive labour. The CTD model replaces prepregnancy BMI with third-trimester BMI and adds estimated gestational age at delivery, hypertensive disease of pregnancy, cervical examination and induction of labour. We included consecutive medical records of eligible women who delivered in 2010. For validation, individual probabilities of women who had an intended VBAC were calculated.Main outcome measuresDiscriminative performance was assessed with the area under the curve (AUC) of the receiver operating characteristic and predictive performance was assessed with calibration plots and the Hosmer-Lemeshow (H-L) statistic.ResultsFive hundred and fifteen (67%) of the 763 women had an intended VBAC; 72% of these (371) had an actual VBAC. The AUCs of the ETC and CTD models were 68% (95% CI 63-72%) and 72% (95% CI 67-76%), respectively. The H-L statistic showed a P-value of 0.167 for the ETC model and P=0.356 for the CTD model, indicating no lack of fit.ConclusionExternal validation of two predictive models developed in the USA revealed an adequate performance within the Dutch population.