A model to predict vaginal delivery in nulliparous women based on maternal characteristics and intrapartum ultrasound

Objective: To develop the prediction models for identifying fetal occiput rotation and vaginal delivery based on intrapartum sonographic findings. Design: Prospective observational study. Setting: Hangzhou, China. Population: Nulliparous women with a singleton cephalic presentation at term. Methods: Serial intrapartum ultrasonography were performed in the latent phase (T1) and every three hours after that (T2, T3 and T4). The managing clinicians performed paired digital vaginal examinations to assess labor progress. Main Outcome Measures: Delivery mode and successful internal fetal head rotation to the occiput anterior (OA) position. Results: 614 women were included, of whom 524 underwent vaginal delivery, and 90 required cesarean section. The percentage of women with fetuses in non-occiput anterior position at the latent phase was 53.9% (331 cases), as 257 women underwent spontaneous rotation to OA position before delivery, 74 were with persistent occiput posterior or transverse position. We developed a model on the basis of the maternal height and middle angel to predict the spontaneous fetal occiput rotation, with the area under the receiver operating characteristic curve (AUC) was 0.667 (95%CI 0.583-0.751). Moreover, a prediction model based on the maternal height and angle of progression to evaluate whether women underwent vaginal delivery was also developed, of which the AUC was 0.738(95% CI: 0.763-0.793). Both models showed satisfactory calibration. Conclusion: Simple models based on maternal characteristics and intrapartum ultrasound findings might provide useful information for predicting vaginal delivery and internal fetal occiput rotation.

Download Full-text

Predicting Vaginal Delivery in Nulliparous Women Undergoing Induction of Labor at Term

American Journal of Perinatology ◽

10.1055/s-0037-1608847 ◽

2017 ◽

Vol 35 (07) ◽

pp. 660-668 ◽

Cited By ~ 3

Author(s):

U. M. Reddy ◽

C. C. Huang ◽

T. C. Auguste ◽

D. Bauer ◽

R. T. Overcash ◽

...

Keyword(s):

Vaginal Delivery ◽

Characteristic Curve ◽

Area Under The Curve ◽

Predictive Ability ◽

Induction Of Labor ◽

Stepwise Logistic Regression ◽

Chronic Hypertension ◽

Stepwise Logistic Regression Analysis ◽

Maternal Characteristics ◽

Nulliparous Women

Objective We sought to develop a model to calculate the likelihood of vaginal delivery in nulliparous women undergoing induction at term. Study Design We obtained data from the Consortium on Safe Labor by including nulliparous women with term singleton pregnancies undergoing induction of labor at term. Women with contraindications for vaginal delivery were excluded. A stepwise logistic regression analysis was used to identify the predictors associated with vaginal delivery by considering maternal characteristics and comorbidities and fetal conditions. The receiver operating characteristic curve, with an area under the curve (AUC) was used to assess the accuracy of the model. Results Of 10,591 nulliparous women who underwent induction of labor, 8,202 (77.4%) women had vaginal delivery. Our model identified maternal age, gestational age at delivery, race, maternal height, prepregnancy weight, gestational weight gain, cervical exam on admission (dilation, effacement, and station), chronic hypertension, gestational diabetes, pregestational diabetes, and abruption as significant predictors for successful vaginal delivery. The overall predictive ability of the final model, as measured by the AUC was 0.759 (95% confidence interval, 0.749–0.770). Conclusion We identified independent risk factors that can be used to predict vaginal delivery among nulliparas undergoing induction at term. Our predictor provides women with additional information when considering induction.

Download Full-text

Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review

Obstetrics and Gynecology ◽

10.1097/01.aog.0000139787.28726.5f ◽

2004 ◽

Vol 104 (3) ◽

pp. 626-627

Keyword(s):

Systematic Review ◽

Caesarean Section ◽

Vaginal Delivery ◽

Opioid Analgesia ◽

Low Concentration ◽

Nulliparous Women

Download Full-text

Predictive Factors for Successful Vaginal Delivery after a Trial of External Cephalic Version: A Retrospective Cohort Study of 946 Women

American Journal of Perinatology ◽

10.1055/s-0041-1739505 ◽

2021 ◽

Author(s):

Asaf Bilgory ◽

Olena Minich ◽

Maria Shvaikovsky ◽

Genady Gurevich ◽

Joseph B. Lessing ◽

...

Keyword(s):

Cohort Study ◽

Vaginal Delivery ◽

Predictive Factors ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Goodness Of Fit ◽

External Cephalic Version ◽

Nulliparous Women ◽

Tertiary Center ◽

Vertex Presentation

Objective Our aim was to find the factors which predict a vertex presentation of vaginal delivery (VD) in women who are admitted for a trial of external cephalic version (ECV). Study Design This is a retrospective cohort study of women who underwent a trial of ECV and delivered between November 2011 and December 2018 in a single tertiary center. The main outcome measure was successful VD of a fetus in the vertex presentation. Women who achieved VD in the vertex presentation or underwent cesarean delivery were compared on the basis of variety of predictive factors. Adverse neonatal and maternal outcomes were reported. Logistic regression was used for the multivariate analysis. Results A total of 946 women were included; 717 (75.8%) women had a successful ECV and 663 (70.1%) women had a VD in the vertex presentation. Parous women had 79.3% VD rate (570/719) and nulliparous women had 41.0% VD rate (93/227). Women with an amniotic fluid index (AFI) of 50 to 79, 80 to 200, and >200 mm had 34.8, 71.0, and 83.1% VD rate, respectively. Parous versus nulliparous women had an adjusted odds ratio (aOR) of 5.42 (95% confidence interval [CI] 3.90–7.52, p < 0.001), women with AFI 50 to 79 mm compared with AFI 80 to 200 mm had an aOR of 0.21 (95% CI 0.12–0.37, p < 0.001), and women with an AFI >200 mm compared with AFI 80 to 200 mm had an aOR of 1.74 (95% CI 1.03–2.92, p = 0.037) to achieve VD. The final prediction model for the chances of a VD based on data on admission for ECV was reported. The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model (p = 0.836). Conclusion Being parous and having an AFI >200 mm are positive independent predictive factors for achieving VD of a vertex presenting fetus after ECV. Whereas AFI 50 to 79 mm is a negative independent predictive factor. Key Points

Download Full-text

Prediction of vaginal delivery with transperineal ultrasound in women induced with dinoprostone beyond 40 weeks of gestation

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20183290 ◽

2018 ◽

Vol 7 (8) ◽

pp. 2998

Author(s):

Hale Göksever Çelik ◽

Engin Çelik ◽

Gökhan Yıldırım

Keyword(s):

Pregnant Women ◽

Vaginal Delivery ◽

Prospective Observational Study ◽

Transperineal Ultrasound ◽

Direct Visualization ◽

Fetal Head ◽

Nulliparous Women ◽

Multiparous Women ◽

High Possibility ◽

Angle Of Progression

Background: Digital cervical evaluation has been used to determine the likelihood of vaginal delivery which is considered by many women to be non-tolerable. Recently, transperineal ultrasound allowing direct visualization of the fetal skull has been using for the prediction of labor route. Authors aimed to study whether measurements on transperineal ultrasound are predictive for vaginal delivery in pregnant women induced with dinoprostone at 40.0-42.0 gestational weeks.Methods: A total of 55 pregnant women at 40.0-42.0 gestational weeks were enrolled in this prospective observational study. All participated women were examined before the induction with dinoprostone to measure the head-perineum distance (HPD), the head-pubis distance and the angle of progression of fetal head (AOP).Results: The greater AOP, the shorter HPD and the head-pubis distance were associated with vaginal delivery in the nulliparous women. The HPD and the head-pubis distance were shorter, whereas the AOP was greater in the multiparous women giving birth by vaginal route.Conclusions: Transperineal ultrasound can be applied at the beginning of labor to predict whether vaginal delivery will occur or not. As shown in our study, the pregnant women with shorter HPD and wider AOP might have a high possibility to achieve vaginal delivery.

Download Full-text

Prediction of pre-eclampsia in nulliparous women using routinely collected maternal characteristics: A model development and validation study

10.21203/rs.2.16757/v1 ◽

2019 ◽

Author(s):

Ziad TA Al-Rubaie ◽

H Malcolm Hudson ◽

Gregory Jenkins ◽

Imad Mahmoud ◽

Joel G Ray ◽

...

Keyword(s):

High Risk ◽

Public Hospitals ◽

Local Health ◽

Goodness Of Fit Test ◽

Entire Study ◽

Maternal Characteristics ◽

Maternal Risk ◽

Risk Threshold ◽

Nulliparous Women ◽

Aspirin Prophylaxis

Abstract Background Guidelines recommend identifying early in pregnancy women at elevated risk of pre-eclampsia. The aim of this study was to develop and validate a pre-eclampsia risk prediction model for nulliparous women attending routine antenatal care “the Western Sydney (WS) model”; and to compare its performance with the National Institute of Health and Care Excellence (NICE) risk factor-list approach for classifying women as high-risk.Methods This retrospective cohort study included all nulliparous women who gave birth in three public hospitals in the Western-Sydney-Local-Health-District, Australia 2011-2014. Using births from 2011-2012, multivariable logistic regression incorporated established maternal risk factors to develop and internally validate the WS model. The WS model was then externally validated using births from 2013-2014, assessing its discrimination and calibration. We fitted the final WS model for all births from 2011-2014, and compared its accuracy in predicting pre-eclampsia with the NICE approach.Results Among 12,395 births to nulliparous women in 2011-2014, there were 293 (2.4%) pre-eclampsia events. The WS model included maternal age, body mass index, ethnicity, multiple pregnancy, family history of pre-eclampsia, autoimmune disease, chronic hypertension and chronic renal disease. In the validation sample (6201 births), the model c-statistic was 0.70 (95% confidence interval 0.65–0.75). The observed:expected ratio for pre-eclampsia was 0.91, with a Hosmer-Lemeshow goodness-of-fit test p-value of 0.20. In the entire study sample of 12,395 births, 374 (3.0%) women had a WS model-estimated pre-eclampsia risk ≥8%, the pre-specified risk-threshold for considering aspirin prophylaxis. Of these, 54 (14.4%) developed pre-eclampsia (sensitivity 18% (14–23), specificity 97% (97–98)). Using the NICE approach, 1173 (9.5%) women were classified as high-risk, of which 107 (9.1%) developed pre-eclampsia (sensitivity 37% (31-42), specificity 91% (91–92)). The final model showed similar accuracy to the NICE approach when using lower risk-threshold of ≥4% to classify women as high-risk for pre-eclampsia.Conclusion The WS risk model that combines readily-available maternal characteristics achieved modest performance for prediction of pre-eclampsia in nulliparous women. The model did not outperform the NICE approach, but has the advantage of providing individualised absolute risk estimates, to assist with counselling, inform decisions for further testing, and consideration of aspirin prophylaxis.

Download Full-text

Prediction of pre-eclampsia in nulliparous women using routinely collected maternal characteristics: A model development and validation study

10.21203/rs.2.16757/v3 ◽

2019 ◽

Author(s):

Ziad TA Al-Rubaie ◽

H Malcolm Hudson ◽

Gregory Jenkins ◽

Imad Mahmoud ◽

Joel G Ray ◽

...

Keyword(s):

High Risk ◽

Public Hospitals ◽

Local Health ◽

Goodness Of Fit Test ◽

Entire Study ◽

Maternal Characteristics ◽

Maternal Risk ◽

Risk Threshold ◽

Nulliparous Women ◽

Aspirin Prophylaxis

Abstract Background Guidelines recommend identifying in early pregnancy women at elevated risk of pre-eclampsia. The aim of this study was to develop and validate a pre-eclampsia risk prediction model for nulliparous women attending routine antenatal care “the Western Sydney (WS) model”; and to compare its performance with the National Institute of Health and Care Excellence (NICE) risk factor-list approach for classifying women as high-risk. Methods This retrospective cohort study included all nulliparous women who gave birth in three public hospitals in the Western-Sydney-Local-Health-District, Australia 2011-2014. Using births from 2011-2012, multivariable logistic regression incorporated established maternal risk factors to develop and internally validate the WS model. The WS model was then externally validated using births from 2013-2014, assessing its discrimination and calibration. We fitted the final WS model for all births from 2011-2014, and compared its accuracy in predicting pre-eclampsia with the NICE approach. Results Among 12,395 births to nulliparous women in 2011-2014, there were 293 (2.4%) pre-eclampsia events. The WS model included: maternal age, body mass index, ethnicity, multiple pregnancy, family history of pre-eclampsia, autoimmune disease, chronic hypertension and chronic renal disease. In the validation sample (6201 births), the model c-statistic was 0.70 (95% confidence interval 0.65–0.75). The observed:expected ratio for pre-eclampsia was 0.91, with a Hosmer-Lemeshow goodness-of-fit test p-value of 0.20. In the entire study sample of 12,395 births, 374 (3.0%) women had a WS model-estimated pre-eclampsia risk ≥8%, the pre-specified risk-threshold for considering aspirin prophylaxis. Of these, 54 (14.4%) developed pre-eclampsia (sensitivity 18% (14–23), specificity 97% (97–98)). Using the NICE approach, 1173 (9.5%) women were classified as high-risk, of which 107 (9.1%) developed pre-eclampsia (sensitivity 37% (31-42), specificity 91% (91–92)). The final model showed similar accuracy to the NICE approach when using lower risk-threshold of ≥4% to classify women as high-risk for pre-eclampsia. Conclusion The WS risk model that combines readily-available maternal characteristics achieved modest performance for prediction of pre-eclampsia in nulliparous women. The model did not outperform the NICE approach, but has the advantage of providing individualised absolute risk estimates, to assist with counselling, inform decisions for further testing, and consideration of aspirin prophylaxis.

Download Full-text

Reduction of maternal and neonatal harm through prevention of the primary Cesarean section

University of Western Ontario Medical Journal ◽

10.5206/uwomj.v85i2.2222 ◽

2016 ◽

Vol 85 (2) ◽

pp. 19-21

Author(s):

Andrew Welton

Keyword(s):

Cesarean Section ◽

Vaginal Delivery ◽

Common Knowledge ◽

Multiple Pregnancy ◽

Expectant Management ◽

Breech Presentation ◽

Active Phase ◽

External Cephalic Version ◽

Second Stage ◽

Nulliparous Women

While there are clear life-saving indications for Cesarean section (C-section), rates of this procedure have seen a continued rise without a concomitant improvement in maternal or neonatal outcomes. There is some evidence that outcomes may actually be worse for low-risk C-sections versus vaginal delivery. However, this is not necessarily common knowledge for healthcare providers, and therefore, their patients. Measures to safely reduce the C-section rate target management of labour arrest and specific indications for progression to C-section. In the active phase of the first stage of labour, C-section should be considered only in cases of failure to progress after 4 hours of adequate uterine contraction, or 6 hours of inadequate contraction. In the second stage of labour, expectant management of 3 hours of pushing in nulliparous women and 2 hours in multiparous women is safe and appropriate. Furthermore, manual rotation and operative vaginal delivery in the second stage are reasonable alternatives to C-section. Expectant management is also appropriate for certain non-reassuring fetal heart rate tracings. In post-dates pregnancies, induction of labour reduces both rates of C-section and neonatal mortality. Finally, evidence supports the use of external cephalic version in breech presentation as well as a more conservative approach to suspected macrosomia and multiple pregnancy. Taken together, these measures target the most common indications for progression to C-section and can allow us to safely reduce the C-section rate. Educating patients and physicians on the risks of the procedure and reasonable alternatives can improve outcomes for mothers and neonates.

Download Full-text