Haggiag Noa, Eitan Shani, Maor-Sagie Esther, Hallak Mordechai, Gabbay-Benziv Rinat
Hillel Yaffe Medical Center, Hadera, Israel.
The Rappaport Faculty of Medicine Technion, Haifa, Israel.
Int J Gynaecol Obstet. 2023 Apr;161(1):182-189. doi: 10.1002/ijgo.14439. Epub 2022 Sep 16.
To validate the Maternal Fetal Medicine Unit's (MFMU) vaginal birth after cesarean delivery (VBAC) calculator in an Israeli cohort, and to detect other variables associated with VBAC and construct an improved VBAC calculator.
A retrospective cohort study was performed at a single university-affiliated medical center. Women carrying a singleton, term, cephalic-presenting fetus, with previous one low transverse cesarean delivery who opted for trial of VBAC were included. Demographic and obstetric characteristics were incorporated into the MFMU's calculator, to predict probabilities of VBAC and compare prediction performance with the original publication utilizing receiver operating characteristic (ROC) statistics. Logistic regression analysis was used to investigate other variables and construct an improved model for success of VBAC.
Of 490 parturients, 396 (80.8%) had a successful vaginal delivery. Compared to the original publication, the MFMU's calculator underperformed: area under the ROC curve (AUC) was 0.709 (95% confidence interval [CI] 0.652-0.766, P < 0.001). Sensitivity, specificity, positive and negative predictive values, and overall accuracy were 67.42%, 65.96%, 89.30%, 32.46%, and 32.46%, respectively. An improved model that included previous VBAC, prior vaginal delivery, spontaneous onset of delivery, and maternal diabetes resulted in improved prediction performance with an AUC of 0.771 (95% CI 0.723-0.82, P < 0.001).
MFMU's VBAC calculator needs to be validated in different populations before implementation.
在以色列队列中验证母胎医学科（MFMU）的剖宫产术后阴道分娩（VBAC）计算器，并检测与VBAC相关的其他变量，构建改进的VBAC计算器。
在一家大学附属医院进行了一项回顾性队列研究。纳入单胎、足月、头先露胎儿、既往有一次低位横切口剖宫产且选择VBAC试产的妇女。将人口统计学和产科特征纳入MFMU的计算器，以预测VBAC的概率，并利用受试者工作特征（ROC）统计量将预测性能与原始出版物进行比较。采用逻辑回归分析研究其他变量，并构建改进的VBAC成功模型。
490例产妇中，396例（80.8%）阴道分娩成功。与原始出版物相比，MFMU的计算器表现不佳：ROC曲线下面积（AUC）为0.709（95%置信区间[CI]0.652-0.766，P<0.001）。敏感性、特异性、阳性和阴性预测值以及总体准确率分别为67.42%、65.96%、89.30%、32.46%和32.46%。一个改进的模型纳入了既往VBAC、既往阴道分娩、自然发动分娩和母体糖尿病，预测性能得到改善，AUC为0.771（95%CI 0.723-0.82，P<0.001）。
MFMU的VBAC计算器在实施前需要在不同人群中进行验证。
