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Validation of prediction model for successful vaginal birth after Cesarean delivery based on sonographic assessment of hysterotomy scar

Baranov, A. LU ; Salvesen, K. LU and Vikhareva, O. LU (2018) In Ultrasound in Obstetrics and Gynecology 51(2). p.189-193
Abstract

Objective: To validate a prediction model for successful vaginal birth after Cesarean delivery (VBAC) based on sonographic assessment of the hysterotomy scar, in a Swedish population. Methods: Data were collected from a prospective cohort study. We recruited non-pregnant women aged 18–35 years who had undergone one previous low-transverse Cesarean delivery at ≥ 37 gestational weeks and had had no other uterine surgery. Participants who subsequently became pregnant underwent transvaginal ultrasound examination of the Cesarean hysterotomy scar at 11 + 0 to 13 + 6 and at 19 + 0 to 21 + 6 gestational weeks. Thickness of the myometrium at the thinnest part of the scar area was measured. After delivery, information on pregnancy outcome was... (More)

Objective: To validate a prediction model for successful vaginal birth after Cesarean delivery (VBAC) based on sonographic assessment of the hysterotomy scar, in a Swedish population. Methods: Data were collected from a prospective cohort study. We recruited non-pregnant women aged 18–35 years who had undergone one previous low-transverse Cesarean delivery at ≥ 37 gestational weeks and had had no other uterine surgery. Participants who subsequently became pregnant underwent transvaginal ultrasound examination of the Cesarean hysterotomy scar at 11 + 0 to 13 + 6 and at 19 + 0 to 21 + 6 gestational weeks. Thickness of the myometrium at the thinnest part of the scar area was measured. After delivery, information on pregnancy outcome was retrieved from hospital records. Individual probabilities of successful VBAC were calculated using a previously published model. Predicted individual probabilities were divided into deciles. For each decile, observed VBAC rates were calculated. To assess the accuracy of the prediction model, receiver–operating characteristics curves were constructed and the areas under the curves (AUC) were calculated. Results: Complete sonographic data were available for 120 women. Eighty (67%) women underwent trial of labor after Cesarean delivery (TOLAC) with VBAC occurring in 70 (88%) cases. The scar was visible in all 80 women at the first-trimester scan and in 54 (68%) women at the second-trimester scan. AUC was 0.44 (95% CI, 0.28–0.60) among all women who underwent TOLAC and 0.51 (95% CI, 0.32–0.71) among those with the scar visible sonographically at both ultrasound examinations. Conclusion: The prediction model demonstrated poor accuracy for prediction of successful VBAC in our Swedish population.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cesarean delivery, prediction model, vaginal birth after Cesarean delivery
in
Ultrasound in Obstetrics and Gynecology
volume
51
issue
2
pages
5 pages
publisher
John Wiley & Sons
external identifiers
  • scopus:85041688475
ISSN
0960-7692
DOI
10.1002/uog.17439
language
English
LU publication?
yes
id
ead3b80b-e968-41d6-b29d-d45c8648d646
date added to LUP
2018-03-06 12:30:44
date last changed
2018-05-29 10:04:46
@article{ead3b80b-e968-41d6-b29d-d45c8648d646,
  abstract     = {<p>Objective: To validate a prediction model for successful vaginal birth after Cesarean delivery (VBAC) based on sonographic assessment of the hysterotomy scar, in a Swedish population. Methods: Data were collected from a prospective cohort study. We recruited non-pregnant women aged 18–35 years who had undergone one previous low-transverse Cesarean delivery at ≥ 37 gestational weeks and had had no other uterine surgery. Participants who subsequently became pregnant underwent transvaginal ultrasound examination of the Cesarean hysterotomy scar at 11 + 0 to 13 + 6 and at 19 + 0 to 21 + 6 gestational weeks. Thickness of the myometrium at the thinnest part of the scar area was measured. After delivery, information on pregnancy outcome was retrieved from hospital records. Individual probabilities of successful VBAC were calculated using a previously published model. Predicted individual probabilities were divided into deciles. For each decile, observed VBAC rates were calculated. To assess the accuracy of the prediction model, receiver–operating characteristics curves were constructed and the areas under the curves (AUC) were calculated. Results: Complete sonographic data were available for 120 women. Eighty (67%) women underwent trial of labor after Cesarean delivery (TOLAC) with VBAC occurring in 70 (88%) cases. The scar was visible in all 80 women at the first-trimester scan and in 54 (68%) women at the second-trimester scan. AUC was 0.44 (95% CI, 0.28–0.60) among all women who underwent TOLAC and 0.51 (95% CI, 0.32–0.71) among those with the scar visible sonographically at both ultrasound examinations. Conclusion: The prediction model demonstrated poor accuracy for prediction of successful VBAC in our Swedish population.</p>},
  author       = {Baranov, A. and Salvesen, K. and Vikhareva, O.},
  issn         = {0960-7692},
  keyword      = {Cesarean delivery,prediction model,vaginal birth after Cesarean delivery},
  language     = {eng},
  number       = {2},
  pages        = {189--193},
  publisher    = {John Wiley & Sons},
  series       = {Ultrasound in Obstetrics and Gynecology},
  title        = {Validation of prediction model for successful vaginal birth after Cesarean delivery based on sonographic assessment of hysterotomy scar},
  url          = {http://dx.doi.org/10.1002/uog.17439},
  volume       = {51},
  year         = {2018},
}