Bhardwaj Mahak, Gainder Shalini, Chopra Seema, Bagga Rashmi, Saini Shiv Sajan
Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh, India.
Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh, India.
Eur J Obstet Gynecol Reprod Biol X. 2023 Mar 30;18:100188. doi: 10.1016/j.eurox.2023.100188. eCollection 2023 Jun.
To validate Grobman's nomogram for prediction of trial of labour after caesarean section (TOLAC) success in the Indian population.
A prospective observational study of women with previous lower segment caesarean sections (LSCS) who were admitted for TOLAC between January 2019 and June 2020 at a tertiary care hospital We compared the Grobman's predicted VBAC success probability to the observed VBAC rate in the study population and devised a receiver-operator characteristics (ROC) curve for the nomogram.
Among the 124 women with prior LSCS who chose TOLAC and were included in the study, 68 (54.8%) had a successful VBAC and 56 (45.2%) had a failed TOLAC. The mean Grobman's predicted success probability for the cohort was 76.7%, significantly higher in VBAC women versus CS women (80.6% vs. 72.1%; p 0.001). The VBAC rate was 69.1% with a predicted probability of > 75% and only 42.9% with a probability of 50%. Women in the > 75% probability group had a nearly similar observed and predicted VBAC rate (69.1% vs. 86.3%; p = 0.002), and a greater number of women in the 50% probability group had successful VBAC than predicted (42.9% vs. 39.5%; p = 0.018). The area under the ROC curve for the study was 0.703 (95% CI 0.609-0.797; p 0.001). Grobman's nomogram had a sensitivity of 57.35%, a specificity of 82.14%, a positive predictive value (PPV) of 79.59%, and a negative predictive value (NPV) of 61.33% at a predicted probability cut-off of 82.5%.
Women who had a higher Grobman's predicted probability had greater VBAC success rates than those with low predicted probability scores. The prediction ability of the nomogram was highly accurate at higher predicted probabilities, and even at lower predicted probabilities, women did have good odds of delivering vaginally.
验证格罗布曼列线图在预测印度人群剖宫产术后阴道试产（TOLAC）成功率方面的有效性。
对2019年1月至2020年6月期间在一家三级护理医院因TOLAC入院的有既往下段剖宫产史（LSCS）的女性进行一项前瞻性观察研究。我们将格罗布曼预测的阴道分娩成功率与研究人群中观察到的阴道分娩率进行比较，并为该列线图绘制了受试者操作特征（ROC）曲线。
在124例选择TOLAC并纳入研究的有既往LSCS史的女性中，68例（54.8%）阴道分娩成功，56例（45.2%）TOLAC失败。该队列的格罗布曼预测成功率均值为76.7%，阴道分娩成功的女性显著高于剖宫产的女性（80.6%对72.1%；p<0.001）。预测概率>75%时，阴道分娩率为69.1%，而概率为50%时仅为42.9%。预测概率>75%组的女性观察到的和预测的阴道分娩率几乎相似（69.1%对86.3%；p = 0.002），50%概率组中阴道分娩成功的女性数量比预测的多（42.9%对39.5%；p = 0.018）。该研究的ROC曲线下面积为0.703（95%CI 0.609 - 0.797；p<0.001）。在预测概率临界值为82.5%时，格罗布曼列线图的灵敏度为57.35%，特异度为82.14%，阳性预测值（PPV）为79.59%，阴性预测值（NPV）为61.33%。
格罗布曼预测概率较高的女性阴道分娩成功率高于预测概率得分低的女性。列线图在较高预测概率时预测能力高度准确，即使在较低预测概率时，女性经阴道分娩的几率也较高。
