Nguyen Michelle T, Hayes-Bautista Teodocia Maria, Hsu Paul, Bragg Christina, Chopin Irving, Shaw Kathryn J
Department of Obstetrics and Gynecology, Adventist Health White Memorial Medical Center, Los Angeles, California.
Department of Graduate Medical Education, Adventist Health White Memorial Medical Center, Los Angeles, California.
AJP Rep. 2020 Apr;10(2):e148-e154. doi: 10.1055/s-0040-1708493. Epub 2020 Apr 15.
The Maternal-Fetal Medicine Units (MFMU) Network developed a prediction model for calculating the likelihood of successful vaginal birth after cesarean (VBAC) in patients undergoing a trial of labor after cesarean (TOLAC). In this prediction model, Latina ethnicity is considered a negative predictive factor for successful VBAC. Subsequent studies have found mixed results regarding VBAC success in Latina ethnicity. Our aim was to compare the predicted chance of successful VBAC (as calculated using the MFMU prediction model) to actual TOLAC outcomes in a large Latina sample. We performed a retrospective cohort study of Latinas who underwent TOLAC at our institution from January 1, 2013 to December 31, 2016. The MFMU prediction model was used to calculate each participant's predicted success, and the participants were then categorized into three groups based on predicted success: low (<35%), moderate (35-65%), and high (>65%). The predicted success rates versus actual outcomes were compared among the three groups. A total of 567 Latinas met inclusion criteria. Successful VBAC occurred in 476 patients (84%). VBAC was achieved in 65.3% of the low predicted success group, 84.4% of the moderate predicted success group, and 91.7% of the predicted high success group. Actual VBAC success rates exceeded the predicted success rates for the low and moderate groups. Our results question whether Latina ethnicity should continue to be considered a negative predictive factor for VBAC success. Our results also suggest that Latinas with a low predicted VBAC success should not necessarily be discouraged from attempting TOLAC.
母胎医学单位（MFMU）网络开发了一种预测模型，用于计算剖宫产术后试产（TOLAC）患者成功阴道分娩（VBAC）的可能性。在这个预测模型中，拉丁裔被认为是VBAC成功的一个负面预测因素。随后的研究发现，关于拉丁裔VBAC成功的结果不一。我们的目的是在一个大型拉丁裔样本中，比较预测的VBAC成功机会（使用MFMU预测模型计算）与实际的TOLAC结果。我们对2013年1月1日至2016年12月31日在我们机构接受TOLAC的拉丁裔进行了一项回顾性队列研究。使用MFMU预测模型计算每个参与者的预测成功率，然后根据预测成功率将参与者分为三组：低（<35%）、中（35-65%）和高（>65%）。比较三组的预测成功率与实际结果。共有567名拉丁裔符合纳入标准。476名患者（84%）成功实现VBAC。在预测成功率低的组中，VBAC成功率为65.3%，在预测成功率中等的组中为84.4%，在预测成功率高的组中为91.7%。低和中等组的实际VBAC成功率超过了预测成功率。我们的结果质疑拉丁裔是否应继续被视为VBAC成功的负面预测因素。我们的结果还表明，预测VBAC成功率低的拉丁裔不一定应被劝阻尝试TOLAC。
