Department of Obstetrics and Gynecology, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura, Nagoya, Japan.
Int J Med Sci. 2012;9(6):488-91. doi: 10.7150/ijms.4682. Epub 2012 Aug 15.
To validate a previously developed prediction model for vaginal birth after cesarean (VBAC) using a Japanese cohort.
We performed a cohort study of all term pregnant women with a vertex position, singleton gestation, and one prior low transverse cesarean delivery attempting a trial of labor between April 1985 and March 2010. Variables necessary for the prediction of successful VBAC were maternal age, pre-pregnancy body mass index, ethnicity, prior vaginal delivery, prior VBAC, and indication for prior cesarean delivery. They were extracted from medical records and put into the formula that calculates an individual woman's predicted VBAC success rate. The predicted rates were then partitioned into deciles and compared with the actual VBAC rates. The predictive ability of the model was assessed with a receiver operating characteristic and the area under the curve (AUC) was determined.
Seven hundred and twenty-five women who met the inclusion criteria had complete data available, of which 664 (91.6%) had VBAC. The predicted probability of VBAC, as calculated by the regression equation, was significantly higher in those who had a successful trial of labor (median 80.1%, interquartile range 71.5-88.7) than those who did not (median 69.4%, interquartile range 59.9-78.9, P<0.001). The predictive model had AUC of 0.80, which was comparative to the originally described one. When the predicted rates were each deciles of over 70%, the actual success rates were more than 90%.
The previously published prediction model for VBAC developed in the USA is also available to Japanese women.
使用日本队列验证先前开发的用于剖宫产阴道分娩（VBAC）的预测模型。
我们对所有 1985 年 4 月至 2010 年 3 月期间尝试试产的具有头位、单胎妊娠和一次既往低位横切口剖宫产的足月孕妇进行了队列研究。用于预测 VBAC 成功的变量包括产妇年龄、孕前体重指数、种族、既往阴道分娩、既往 VBAC 和既往剖宫产的指征。这些变量从病历中提取出来，并纳入到计算个体女性预测 VBAC 成功率的公式中。然后将预测率分为十分位数，并与实际 VBAC 率进行比较。使用接收者操作特征评估模型的预测能力，并确定曲线下面积（AUC）。
符合纳入标准的 725 名妇女有完整的数据，其中 664 名（91.6%）成功 VBAC。根据回归方程计算的 VBAC 预测概率，在试产成功的妇女中明显更高（中位数 80.1%，四分位距 71.5-88.7），而在试产失败的妇女中则较低（中位数 69.4%，四分位距 59.9-78.9，P<0.001）。预测模型的 AUC 为 0.80，与最初描述的模型相当。当预测率超过 70%的每个十分位数时，实际成功率超过 90%。
先前在美国开发的用于 VBAC 的预测模型也适用于日本妇女。
