Maastricht Universitair Medisch Centrum, GROW-School for Oncology and Developmental Biology, Department of Obstetrics and Gynecology, Maastricht, Netherlands.
Maastricht University Medical Centre, Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht, Limburg, Netherlands.
J Perinat Med. 2020 Nov 6;49(3):357-363. doi: 10.1515/jpm-2020-0308. Print 2021 Mar 26.
Discussing the individual probability of a successful vaginal birth after caesarean (VBAC) can support decision making. The aim of this study is to externally validate a prediction model for the probability of a VBAC in a Dutch population.
In this prospective cohort study in 12 Dutch hospitals, 586 women intending VBAC were included. Inclusion criteria were singleton pregnancies with a cephalic foetal presentation, delivery after 37 weeks and one previous caesarean section (CS) and preference for intending VBAC. The studied prediction model included six predictors: pre-pregnancy body mass index, previous vaginal delivery, previous CS because of non-progressive labour, Caucasian ethnicity, induction of current labour, and estimated foetal weight ≥90th percentile. The discriminative and predictive performance of the model was assessed using receiver operating characteristic curve analysis and calibration plots.
The area under the curve was 0.73 (CI 0.69-0.78). The average predicted probability of a VBAC according to the prediction model was 70.3% (range 33-92%). The actual VBAC rate was 71.7%. The calibration plot shows some overestimation for low probabilities of VBAC and an underestimation of high probabilities.
The prediction model showed good performance and was externally validated in a Dutch population. Hence it can be implemented as part of counselling for mode of delivery in women choosing between intended VBAC or planned CS after previous CS.
讨论剖宫产后阴道分娩（VBAC）成功的个体可能性可以支持决策。本研究的目的是在荷兰人群中对外科 VBAC 概率预测模型进行验证。
在这项来自 12 家荷兰医院的前瞻性队列研究中，纳入了 586 名打算 VBAC 的女性。纳入标准为单胎妊娠，头位，孕 37 周后分娩，且有一次剖宫产史和 VBAC 意愿。所研究的预测模型包括 6 个预测因素：孕前体重指数、既往阴道分娩史、因产程无进展而进行的剖宫产史、白种人、本次分娩的引产和估计胎儿体重≥第 90 百分位数。采用受试者工作特征曲线分析和校准图评估模型的判别和预测性能。
曲线下面积为 0.73（95%CI：0.69-0.78）。根据预测模型，VBAC 的平均预测概率为 70.3%（范围：33%-92%）。实际 VBAC 率为 71.7%。校准图显示 VBAC 概率低时存在高估，高概率时存在低估。
该预测模型在荷兰人群中表现出良好的性能，并得到了外部验证。因此，它可以作为有剖宫产史的女性在选择 VBAC 或计划性 CS 之间的咨询的一部分，用于指导分娩方式。
