Department of Obstetric, Maternity and Child Health Care Affiliated Hospital，Jiaxing University, Jiaxing, China.
Department of Obstetric, Maternity and Child Health Care Affiliated Hospital，Jiaxing University, Jiaxing, China
BMJ Open. 2021 May 5;11(5):e047433. doi: 10.1136/bmjopen-2020-047433.
With the wide adoption of the two-child policy in China since 2016, a large percentage of women with a history of caesarean delivery plan to have a second child. Accordingly, the rate of vaginal birth after caesarean (VBAC) delivery is increasing. Women attempting repeat VBAC may experience multiple morbidities, which is also one of the leading causes of maternal and perinatal mortality. However, it remains to be addressed how we evaluate factors for successful VBAC. This study aims to use a novel approach to identify a set of potential predictive factors for successful VBAC, especially for Chinese women, to be included in prediction models which can be most applicable to pregnant women in China. We plan to assess all potential predictive factors collected through a comprehensive literature review. Then the certainty of the evidence for the identified potential predictive factors will be assessed using the Grading of Recommendations Assessment, Development and Evaluation process. Finally, a two-round international Delphi survey will be conducted to determine the level of consensus.
This study will apply a methodology through an evidence-based approach. A long list of potential predictive factors for successful VBAC will be extracted and identified through the following stages: First, an up-to-date systematic review of the published literature will be conducted to extract identified potential predictive factors for successful VBAC. Second, an online Delphi survey will be performed to achieve expert consensus on which factors should be included in future prediction models. The online questionnaires will be developed in the field of patient, maternal and fetal-related factors. A two-round international Delphi survey will be distributed to the expert panel in the field of perinatal medicine using Google Forms. Experts will be asked to score each factor using the 9-point Likert rating scale to establish potential predictive factors for the successful VBAC. The expert panel will determine on whether to include, potentially include or exclude predictive factors, based on a systematic review of clinical evidence and the Delphi method.
The study was approved by the Institutional Review Board of the Jiaxing Maternity and Children Healthcare Hospital (approval number: 2019-79). The results of this study will be submitted to international peer-reviewed journals or conferences in perinatal medicine or obstetrics.
自 2016 年中国广泛推行二孩政策以来，很大一部分有剖宫产史的妇女计划生二胎。因此，阴道分娩的比例（VBAC）在增加。尝试重复 VBAC 的女性可能会经历多种并发症，这也是导致产妇和围产儿死亡的主要原因之一。然而，如何评估 VBAC 成功的因素仍有待解决。本研究旨在采用一种新方法，确定一组成功 VBAC 的潜在预测因素，特别是针对中国女性，以便纳入预测模型，这些模型最适用于中国的孕妇。我们计划通过全面的文献综述评估所有潜在的预测因素。然后，使用推荐评估、制定和评估（GRADE）过程评估确定的潜在预测因素的证据确定性。最后，将进行两轮国际 Delphi 调查以确定共识水平。
本研究将采用循证方法的方法。通过以下阶段提取和确定 VBAC 成功的潜在预测因素的长清单：首先，对已发表文献进行最新的系统评价，以提取 VBAC 成功的潜在预测因素。其次，将进行在线 Delphi 调查，以就哪些因素应纳入未来预测模型达成专家共识。在线问卷将在患者、产妇和胎儿相关因素领域开发。两轮国际 Delphi 调查将使用 Google 表单分发给围产期医学领域的专家小组。专家将使用 9 分 Likert 评分量表对每个因素进行评分，以建立 VBAC 成功的潜在预测因素。专家组将根据对临床证据的系统评价和 Delphi 方法，决定是否纳入、潜在纳入或排除预测因素。
该研究得到了嘉兴市妇幼保健院机构审查委员会的批准（批准号：2019-79）。本研究的结果将提交给围产期医学或妇产科的国际同行评审期刊或会议。
