Validation of a Prediction Model for Vaginal Birth after Cesarean Delivery Reveals Unexpected Success in a Diverse American Population

Objective To investigate the validity of a prediction model for success of vaginal birth after cesarean delivery (VBAC) in an ethnically diverse population. Methods We performed a retrospective cohort study of women admitted at a single academic institution for a trial of labor after cesarean from May 2007 to January 2015. Individual predicted success rates were calculated using the Maternal–Fetal Medicine Units Network prediction model. Participants were stratified into three probability-of-success groups: low (<35%), moderate (35–65%), and high (>65%). The actual versus predicted success rates were compared. Results In total, 568 women met inclusion criteria. Successful VBAC occurred in 402 (71%), compared with a predicted success rate of 66% (p = 0.016). Actual VBAC success rates were higher than predicted by the model in the low (57 vs. 29%; p < 0.001) and moderate (61 vs. 52%; p = 0.003) groups. In the high probability group, the observed and predicted VBAC rates were the same (79%). Conclusion When the predicted success rate was above 65%, the model was highly accurate. In contrast, for women with predicted success rates <35%, actual VBAC rates were nearly twofold higher in our population, suggesting that they should not be discouraged by a low prediction score.

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Applying a Prediction Model for Vaginal Birth after Cesarean to a Latina Inner-City Population

American Journal of Perinatology Reports ◽

10.1055/s-0040-1708493 ◽

2020 ◽

Vol 10 (02) ◽

pp. e148-e154

Author(s):

Michelle T. Nguyen ◽

Teodocia Maria Hayes-Bautista ◽

Paul Hsu ◽

Christina Bragg ◽

Irving Chopin ◽

...

Keyword(s):

Prediction Model ◽

Predictive Factor ◽

Vaginal Birth ◽

Success Rates ◽

Vaginal Birth After Cesarean ◽

Maternal Fetal Medicine ◽

Trial Of Labor ◽

City Population ◽

Success Group ◽

Negative Predictive Factor

Abstract Background The Maternal–Fetal Medicine Units (MFMU) Network developed a prediction model for calculating the likelihood of successful vaginal birth after cesarean (VBAC) in patients undergoing a trial of labor after cesarean (TOLAC). In this prediction model, Latina ethnicity is considered a negative predictive factor for successful VBAC. Subsequent studies have found mixed results regarding VBAC success in Latina ethnicity. Objective Our aim was to compare the predicted chance of successful VBAC (as calculated using the MFMU prediction model) to actual TOLAC outcomes in a large Latina sample. Study Design We performed a retrospective cohort study of Latinas who underwent TOLAC at our institution from January 1, 2013 to December 31, 2016. The MFMU prediction model was used to calculate each participant's predicted success, and the participants were then categorized into three groups based on predicted success: low (<35%), moderate (35–65%), and high (>65%). The predicted success rates versus actual outcomes were compared among the three groups. Results A total of 567 Latinas met inclusion criteria. Successful VBAC occurred in 476 patients (84%). VBAC was achieved in 65.3% of the low predicted success group, 84.4% of the moderate predicted success group, and 91.7% of the predicted high success group. Actual VBAC success rates exceeded the predicted success rates for the low and moderate groups. Conclusion Our results question whether Latina ethnicity should continue to be considered a negative predictive factor for VBAC success. Our results also suggest that Latinas with a low predicted VBAC success should not necessarily be discouraged from attempting TOLAC.

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Examining the validity of a predictive model for vaginal birth after cesarean

Journal of Perinatal Medicine ◽

10.1515/jpm-2019-0345 ◽

2019 ◽

Vol 48 (1) ◽

pp. 11-15

Author(s):

Jennifer W.H. Wong ◽

Kurt D.N. Yoshino ◽

Hyeong Jun Ahn ◽

So Yung Choi ◽

Ann L. Chang

Keyword(s):

Success Rate ◽

Operating Characteristic ◽

Characteristic Curve ◽

Vaginal Birth ◽

Success Rates ◽

Vaginal Birth After Cesarean ◽

Single Institution ◽

Maternal Fetal Medicine ◽

Cesarean Deliveries ◽

Operating Characteristic Curve

AbstractBackgroundThe Maternal-Fetal Medicine Units (MFMU) vaginal birth after cesarean (VBAC) calculator, while accurate for candidates with high predicted success rates, is not as accurate for poor candidates. This study examines the calculator’s validity in an understudied multiracial cohort with a high proportion of poor candidates.MethodsThis retrospective study examined women with one or two prior cesarean deliveries who attempted VBAC at a single institution. Subjects were placed into quartiles based on MFMU-predicted success rates. For each quartile, actual and predicted success rates were compared. The calculated area under the receiver operating characteristic curve (AUC) was compared to the original AUC.ResultsThe study included 1604 women. Actual and predicted VBAC rates were similar in the lowest and highest quartile groups, 18.2% vs. 21.2% (n = 11, P > 0.99) and 87.1% vs. 88.5% (n = 1090, P = 0.14), respectively. In the 51–75% predicted success rate group, the actual VBAC rate was higher than the predicted rate, 69.9% vs. 65.5% (n = 394) but not statistically significant (P = 0.07). In the 25–50% predicted success rate group, the actual VBAC rate was significantly higher than the predicted rate 55.1% vs. 39.6% (n = 109, P = 0.002). The actual AUC was lower than the MFMU model, 0.72 [95% confidence interval (CI) 0.69–0.75] vs. 0.77 (95% CI 0.76–0.78) (P < 0.001).ConclusionThe MFMU VBAC calculator’s predicted success rates were comparable to actual success rates for candidates with predicted success rates >75%. As predicted success rates declined, the calculator was increasingly inaccurate and underestimated the success rate. Caution should be taken when using the MFMU VBAC calculator for poor candidates.

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Factors predicting Success of Vaginal Birth after Cesarean Section

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1417 ◽

2016 ◽

Vol 8 (3) ◽

pp. 198-201

Author(s):

Uma Singh ◽

Manju L Verma ◽

S Nisha ◽

Pushpa L Sankhwar ◽

Sabuhi Qureshi

Keyword(s):

Cesarean Section ◽

Success Rate ◽

Cesarean Delivery ◽

Fetal Distress ◽

Vaginal Birth ◽

Vaginal Birth After Cesarean ◽

Trial Of Labor ◽

Emergency Cesarean ◽

Predicting Success ◽

History Of

ABSTRACT Aim The aim of this article is to study the various factors that can predict the success of vaginal birth after cesarean (VBAC) section. Materials and methods A retrospective cohort study of deliveries was conducted from 1 January 2014 to 31 December 2014 by the Department of Obstetrics and Gynecology in our hospital. Patients with previous low transverse cesarean section who had undergone a trial of labor were identified. Maternal inpatient and prenatal records were reviewed in all eligible subjects. During labor, uterine activity and fetal heart rate were monitored. When indicated, oxytocin or prostaglandin E2 was used for induction of labor according to Bishop score. Emergency cesarean delivery was considered in cases with the appearance of scar tenderness, fetal distress, nonprogress of labor, and deep transverse arrest. Results A total of 200 women were eligible for VBAC, but after written informed consent, 131 (65.5%) subjects were given trial of labor at term after one prior cesarean delivery among 3,604 deliveries while 69 (34.5%) subjects opted for elective repeat cesarean section. The overall VBAC success rate was 63.3% (76 of 120) in our study. History of spontaneous labor (p = 0.042) and history of previous vaginal delivery (p = 0.038) were found to be significantly associated with increased chance of success of VBAC, and lesser interdelivery interval was not found to be associated with decreased success rate (p = 0.096). Neither indication of previous cesarean nor birth weight of newborn (>3 kg) was found to be related to the success of VBAC. Conclusion Vaginal birth after cesarean section is a safe practice as long as it is offered with a proper selection of candidates with factors having a high success rate. Physicians need to be aware of factors having a good outcome before counseling mothers so that failure rates decrease and successful VBAC is increased. How to cite this article Verma ML, Nisha S, Singh U, Sankhwar PL, Qureshi S. Factors predicting Success of Vaginal Birth after Cesarean Section. J South Asian Feder Obst Gynae 2016;8(3):198-201.

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Predictors of success of trial of labor after cesarean section: A nested case–control study at public hospitals in Eastern Ethiopia

Women s Health ◽

10.1177/17455065211061960 ◽

2021 ◽

Vol 17 ◽

pp. 174550652110619

Author(s):

Maleda Tefera ◽

Nega Assefa ◽

Kedir Teji Roba ◽

Letta Gedefa

Keyword(s):

Cesarean Section ◽

Cesarean Delivery ◽

Vaginal Birth ◽

Public Hospitals ◽

Vaginal Birth After Cesarean ◽

Eastern Ethiopia ◽

Trial Of Labor ◽

History Of ◽

Nested Case Control

Background: One of the primary reasons for an increase in cesarean sections is obstetricians’ uncertainty about labor trial safety following a previous cesarean section. The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%. However, to the best of our knowledge, there is a scarcity of information on the determinants of vaginal birth after cesarean delivery in the study area. As a result, the purpose of this study was to identify predictors of successful vaginal birth after cesarean delivery in public hospitals in Eastern Ethiopia. Methods: A nested case–control study design was used within a prospective follow-up study conducted from June to October 2020. A total of 220 women who tried vaginal birth after cesarean delivery was included, 110 cases and 110 controls. Cases were women with one previous cesarean section scar and successfully proceed with vaginal delivery. The controls were those with an earlier cesarean section scar and delivered by emergency cesarean section after trial of labor. A pre-tested structured questionnaire was used to gather the information. Multiple logistic regression is used to identify the determinants for the success of vaginal birth after cesarean section; odds ratio with its 95% CI are used to report the findings. Results: We found that living in rural areas (AOR = 2.28; 95% CI (1.85, 12.41)), having a current antenatal care follow-up (AOR = 3.20; 95% CI (1.15, 8.87)) and partograph monitoring of labor (AOR = 4.26; 95% CI (1.90, 9.57)) had a positive association with successful vaginal birth after cesarean section. In contrast, the presence of meconium-stained amniotic liquor (AOR = 0.10; 95% CI (0.01, 0.75)) and history of stillbirth (AOR = 0.07; 95% CI (0.02, 0.53)) reducing the chance of success of the trial. Conclusion: Past obstetric history, such as stillbirth, history of labor trial after primary cesarean section, and prior vaginal birth, were significant predictors for achieving vaginal birth after cesarean section. Antenatal care visit, and partograph follow-up were the current obstetric characteristics positively associated with the trial of labor.

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White’s Classification of Maternal Diabetes and Vaginal Birth After Cesarean Delivery Success in Women Undergoing a Trial of Labor

Obstetrics and Gynecology ◽

10.1097/aog.0b013e3181c534ca ◽

2010 ◽

Vol 115 (1) ◽

pp. 60-64 ◽

Cited By ~ 11

Author(s):

Clint M. Cormier ◽

Mark B. Landon ◽

Yinglei Lai ◽

Catherine Y. Spong ◽

Dwight J. Rouse ◽

...

Keyword(s):

Cesarean Delivery ◽

Maternal Diabetes ◽

Vaginal Birth ◽

Vaginal Birth After Cesarean ◽

Trial Of Labor

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Validation of a Vaginal Birth After Cesarean Delivery Prediction Model in Women With Two Prior Cesarean Deliveries

Obstetrics and Gynecology ◽

10.1097/aog.0000000000000744 ◽

2015 ◽

Vol 125 (4) ◽

pp. 948-952 ◽

Cited By ~ 13

Author(s):

Torri D. Metz ◽

Amanda A. Allshouse ◽

Allison M. Faucett ◽

William A. Grobman

Keyword(s):

Prediction Model ◽

Cesarean Delivery ◽

Vaginal Birth ◽

Vaginal Birth After Cesarean ◽

Cesarean Deliveries

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Validation of the Prediction Model for Success of Vaginal Birth After Cesarean Delivery

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000393161.40038.ae ◽

2011 ◽

Vol 31 (1) ◽

pp. 32-33

Author(s):

M.M. Costantine ◽

K. Fox ◽

B.D. Byers ◽

J. Mateus ◽

L.M. Ghulmiyyah ◽

...

Keyword(s):

Prediction Model ◽

Cesarean Delivery ◽

Vaginal Birth ◽

Vaginal Birth After Cesarean

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Is Early Amniotomy Associated with Higher Likelihood of Vaginal Birth after Cesarean?

American Journal of Perinatology Reports ◽

10.1055/s-0040-1702924 ◽

2020 ◽

Vol 10 (01) ◽

pp. e37-e41

Author(s):

Megan S. Varvoutis ◽

Lauren C. Sayres ◽

Sarah K. Dotters-Katz

Keyword(s):

Foley Catheter ◽

Secondary Analysis ◽

Vaginal Birth ◽

Vaginal Birth After Cesarean ◽

Singleton Pregnancy ◽

Maternal Fetal Medicine ◽

Trial Of Labor ◽

Nulliparous Women ◽

The Impact ◽

Labor Length

Abstract Objective The study aims to reduce cesarean rates, eligible women are being offered an option of vaginal birth after cesarean (VBAC). However, little data exist regarding efficacy of amniotomy as a tool in this population. We sought to evaluate the impact of early amniotomy on VBAC success. Study Design This is a secondary analysis case-control study using the MFMU (Maternal-Fetal Medicine Units Network) Cesarean Registry. Women were included if they had a singleton pregnancy, were attempting VBAC, and underwent induction with artificial rupture of membranes. Cases were defined as subjects with successful VBAC; controls were defined as subjects with failed trial of labor after cesarean (TOLAC). Early amniotomy was defined as amniotomy at <4 cm. Demographic and obstetric characteristics were compared and multivariate logistic regression was performed. Results A total of 1,490 women were included. Early amniotomy occurred in 59.5% with VBAC versus 63.2% with failed TOLAC (p = 0.24). After controlling for body mass index, prior vaginal delivery, African–American race, labor length, gestational age, birthweight, epidural use, Foley catheter balloon ripening, induction method and oxytocin use, early amniotomy was associated with a 34% decrease in VBAC success (p < 0.01). Women who had early amniotomy did not have higher rates of chorioamnionitis (2.8 vs. 2.9%, p > 0.99). Conclusion Unlike data from nulliparous women, our data suggest that induction with early amniotomy does not increase the likelihood of VBAC.

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Outcomes of Spontaneous Labor in Women Undergoing Trial of Labor after Cesarean as Compared with Nulliparous Women: A Retrospective Cohort Study

American Journal of Perinatology ◽

10.1055/s-0037-1619448 ◽

2018 ◽

Vol 35 (09) ◽

pp. 852-857

Author(s):

Julian Robinson ◽

Anjali Kaimal ◽

Sarah Little ◽

Sarah Lassey

Keyword(s):

Cohort Study ◽

Cesarean Delivery ◽

Uterine Rupture ◽

Retrospective Cohort ◽

Secondary Analysis ◽

Vaginal Birth After Cesarean ◽

Maternal Fetal Medicine ◽

Fetal Medicine ◽

Trial Of Labor ◽

Nulliparous Women

Objective The objective of this study was to compare spontaneous labor outcomes in women undergoing trial of labor after cesarean (TOLAC) and nulliparas to better counsel women. Study Design A 4-year retrospective cohort. We included women at term in spontaneous labor with vertex singletons and no more than one prior cesarean delivery. In planned secondary analysis, we focused on a subset of women with a prior cesarean and a predicted likelihood of a successful vaginal delivery of 70% or more based on the Maternal-Fetal Medicine Units-vaginal birth after cesarean (VBAC) calculator. Results Our cohort included 606 TOLACS and 606 nulliparas. Women undergoing TOLAC were more likely to undergo cesarean delivery (25.7 vs. 14.7%; p < 0.001). Severe maternal hemorrhage (1.5 vs. 0.2%; p = 0.02) and uterine rupture (1.9 vs. 0.0%; p < 0.01) were more likely in the TOLAC group. For the subset of women with a predicted likelihood of VBAC of 70% or more, there were no differences in cesarean delivery (16.7 vs. 14.7%; p = 0.51), maternal, or immediate neonatal complications. Conclusion Women undergoing TOLAC were more likely to have a cesarean delivery, hemorrhage, or uterine rupture. Those with more than 70% predicted likelihood of VBAC were no more likely to experience these outcomes. These findings help contextualize the risks of TOLAC for women considering this option.

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