Department of Gynecology and Obstetrics, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Department of Gynecology and Obstetrics, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
Biomed Res Int. 2020 Sep 18;2020:1540460. doi: 10.1155/2020/1540460. eCollection 2020.
External validation of a vaginal birth after cesarean delivery (VBAC) prediction model is important before implementation in other settings. The primary aim of this study is to validate the Grobman prenatal VBAC calculator in the Ethiopian setting. Secondarily, the study was aimed at developing and comparing a new VBAC model that includes both the prenatal and intrapartum variables.
A cross-sectional survey was conducted, complemented by a medical chart review of 268 women admitted at three teaching hospitals of Addis Ababa University and who underwent a trial of labor after one prior cesarean birth. Maternal age, prepregnancy BMI, prior vaginal delivery, prior VBAC, and prior cesarean delivery indication type were included in the Grobman model. Observed delivery outcomes were recorded and then compared with the outcomes predicted by the calculator. We assessed the predictive abilities of the Grobman model and the new model using a receiver operating characteristic (ROC) curve. Multivariate logistic regression analysis was conducted to identify variables associated with successful VBAC.
Out of the 268 participants, 186 (69.4%) (95% CI 57.5-81.3) had successful VBAC. The area under the ROC curve (AUC) of the Grobman model was 0.75 (95% CI 0.69-0.81). Notably, the novel model including both the prenatal and intrapartum variables had a better predictive value than the original model, with an AUC of 0.87 (95% CI 0.81-0.93). Prior VBAC, prepregnancy BMI, fetal membrane status, and fetal station at admission were predictors of VBAC in the newly developed logistic regression model.
The success rate of VBAC was similar to other sub-Saharan African countries. The Grobman model performed adequately in the study setting; however, the model including both the prenatal and intrapartum variables was more predictive. Thus, intrapartum predictors used in the new model should be considered during intrapartum counseling.
在其他环境中实施剖宫产术后阴道分娩（VBAC）预测模型之前，对其进行外部验证非常重要。本研究的主要目的是在埃塞俄比亚环境中验证 Grobman 产前 VBAC 计算器。其次，本研究旨在开发和比较一种新的 VBAC 模型，该模型同时包含产前和产时变量。
采用横断面调查方法，对在亚的斯亚贝巴大学的三所教学医院接受一次剖宫产术后试产的 268 名妇女进行了问卷调查，并对其病历进行了回顾性分析。Grobman 模型中包含产妇年龄、孕前 BMI、既往阴道分娩、既往 VBAC 和既往剖宫产指征类型。记录观察到的分娩结局，并与计算器预测的结果进行比较。我们使用受试者工作特征（ROC）曲线评估 Grobman 模型和新模型的预测能力。采用多变量逻辑回归分析确定与 VBAC 成功相关的变量。
在 268 名参与者中，186 名（69.4%）（95%CI 57.5-81.3）VBAC 成功。Grobman 模型的 ROC 曲线下面积（AUC）为 0.75（95%CI 0.69-0.81）。值得注意的是，包含产前和产时变量的新模型具有比原始模型更好的预测价值，AUC 为 0.87（95%CI 0.81-0.93）。既往 VBAC、孕前 BMI、胎膜状态和入院时胎方位是新开发的逻辑回归模型中 VBAC 的预测因素。
VBAC 的成功率与其他撒哈拉以南非洲国家相似。Grobman 模型在研究环境中表现良好；然而，包含产前和产时变量的模型更具预测性。因此，应在产时咨询中考虑新模型中使用的产时预测因素。
