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Prediction of vaginal birth after cesarean delivery in term gestations: a calculator without race and ethnicity

      Background

      Investigators have attempted to derive tools that could provide clinicians with an easily obtainable estimate of the chance of vaginal birth after cesarean delivery for those who undertake trial of labor after cesarean delivery. One tool that has been validated externally was derived from data from the Maternal-Fetal Medicine Units Cesarean Registry. However, concern has been raised that this tool includes the socially constructed variables of race and ethnicity.

      Objective

      This study aimed to develop an accurate tool to predict vaginal birth after cesarean delivery, using data easily obtainable early in pregnancy, without the inclusion of race and ethnicity.

      Study Design

      This was a secondary analysis of the Cesarean Registry of the Maternal-Fetal Medicine Units Network. The approach to the current analysis is similar to that of the analysis in which the previous vaginal birth after cesarean delivery prediction tool was derived. Specifically, individuals were included in this analysis if they were delivered on or after 37 0/7 weeks’ gestation with a live singleton cephalic fetus at the time of labor and delivery admission, had a trial of labor after cesarean delivery, and had a history of 1 previous low-transverse cesarean delivery. Information was only considered for inclusion in the model if it was ascertainable at an initial prenatal visit. Model selection and internal validation were performed using a cross-validation procedure, with the dataset randomly and equally divided into a training set and a test set. The training set was used to identify factors associated with vaginal birth after cesarean delivery and build the logistic regression predictive model using stepwise backward elimination. A final model was generated that included all variables found to be significant (P<.05). The accuracy of the model to predict vaginal birth after cesarean delivery was assessed using the concordance index. The independent test set was used to estimate classification errors and validate the model that had been developed from the training set, and calibration was assessed. The final model was then applied to the overall analytical population.

      Results

      Of the 11,687 individuals who met the inclusion criteria for this secondary analysis, 8636 (74%) experienced vaginal birth after cesarean delivery. The backward elimination variable selection yielded a model from the training set that included maternal age, prepregnancy weight, height, indication for previous cesarean delivery, obstetrical history, and chronic hypertension. Vaginal birth after cesarean delivery was significantly more likely for women who were taller and had a previous vaginal birth, particularly if that vaginal birth had occurred after a previous cesarean delivery. Conversely, vaginal birth after cesarean delivery was significantly less likely for women whose age was older, whose weight was heavier, whose indication for previous cesarean delivery was arrest of dilation or descent, and who had a history of medication-treated chronic hypertension. The model had excellent calibration between predicted and empirical probabilities and, when applied to the overall analytical population, an area under the receiver operating characteristic curve of 0.75 (95% confidence interval, 0.74–0.77), which is similar to the area under the receiver operating characteristic curve of the previous model (0.75) that included race and ethnicity.

      Conclusion

      We successfully derived an accurate model (available at https://mfmunetwork.bsc.gwu.edu/web/mfmunetwork/vaginal-birth-after-cesarean-calculator), which did not include race or ethnicity, for the estimation of the probability of vaginal birth after cesarean delivery.

      Key words

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      References

        • Martin J.A.
        • Hamilton B.E.
        • Osterman M.J.K.
        • Driscoll A.K.
        Births: final data for 2018.
        Natl Vital Stat Rep. 2019; 68: 1-47
        • Grobman W.A.
        • Lai Y.
        • Landon M.B.
        • et al.
        The change in the rate of vaginal birth after caesarean section.
        Paediatr Perinat Epidemiol. 2011; 25: 37-43
      1. ACOG Practice Bulletin no. 205: vaginal birth after cesarean delivery.
        Obstet Gynecol. 2019; 133: e110-e127
        • Cox K.J.
        Counseling women with a previous cesarean birth: toward a shared decision-making partnership.
        J Midwifery Womens Health. 2014; 59: 237-245
        • Grobman W.A.
        Rates and prediction of successful vaginal birth after cesarean.
        Semin Perinatol. 2010; 34: 244-248
        • Metz T.D.
        • Stoddard G.J.
        • Henry E.
        • Jackson M.
        • Holmgren C.
        • Esplin S.
        Simple, validated vaginal birth after cesarean delivery prediction model for use at the time of admission.
        Obstet Gynecol. 2013; 122: 571-578
        • Baranov A.
        • Salvesen K.Å.
        • Vikhareva O.
        Validation of prediction model for successful vaginal birth after cesarean delivery based on sonographic assessment of hysterotomy scar.
        Ultrasound Obstet Gynecol. 2018; 51: 189-193
        • Beninati M.J.
        • Ramos S.Z.
        • Danilack V.A.
        • Has P.
        • Savitz D.A.
        • Werner E.F.
        Prediction model for vaginal birth after induction of labor in women with hypertensive disorders of pregnancy.
        Obstet Gynecol. 2020; 136: 402-410
        • Grobman W.A.
        • Lai Y.
        • Landon M.B.
        • et al.
        Development of a nomogram for prediction of vaginal birth after cesarean delivery.
        Obstet Gynecol. 2007; 109: 806-812
        • Costantine M.M.
        • Fox K.
        • Byers B.D.
        • et al.
        Validation of the prediction model for success of vaginal birth after cesarean delivery.
        Obstet Gynecol. 2009; 114: 1029-1033
        • Yokoi A.
        • Ishikawa K.
        • Miyazaki K.
        • Yoshida K.
        • Furuhashi M.
        • Tamakoshi K.
        Validation of the prediction model for success of vaginal birth after cesarean delivery in Japanese women.
        Int J Med Sci. 2012; 9: 488-491
        • Chaillet N.
        • Bujold E.
        • Dubé E.
        • Grobman W.A.
        Validation of a prediction model for vaginal birth after caesarean.
        J Obstet Gynaecol Can. 2013; 35: 119-124
        • Mooney S.S.
        • Hiscock R.
        • Clarke I.D.
        • Craig S.
        Estimating success of vaginal birth after caesarean section in a regional Australian population: validation of a prediction model.
        Aust N Z J Obstet Gynaecol. 2019; 59: 66-70
        • Haumonte J.B.
        • Raylet M.
        • Christophe M.
        • et al.
        French validation and adaptation of the Grobman nomogram for prediction of vaginal birth after cesarean delivery.
        J Gynecol Obstet Hum Reprod. 2018; 47: 127-131
        • Misgan E.
        • Gedefaw A.
        • Negash S.
        • Asefa A.
        Validation of a vaginal birth after cesarean delivery prediction model in teaching hospitals of Addis Ababa University: a cross-sectional study.
        BioMed Res Int. 2020; 2020: 1540460
        • Mone F.
        • Harrity C.
        • Mackie A.
        • et al.
        Vaginal birth after caesarean section prediction models: a UK comparative observational study.
        Eur J Obstet Gynecol Reprod Biol. 2015; 193: 136-139
        • Vyas D.A.
        • Eisenstein L.G.
        • Jones D.S.
        Hidden in plain sight - reconsidering the use of race correction in clinical algorithms.
        N Engl J Med. 2020; 383: 874-882
        • Vyas D.A.
        • Jones D.S.
        • Meadows A.R.
        • Diouf K.
        • Nour N.M.
        • Schantz-Dunn J.
        Challenging the use of race in the vaginal birth after cesarean section calculator.
        Womens Health Issues. 2019; 29: 201-204
        • Ioannidis J.P.A.
        • Powe N.R.
        • Yancy C.
        Recalibrating the use of race in medical research.
        JAMA. 2021; 325: 623-624
        • Landon M.B.
        • Hauth J.C.
        • Leveno K.J.
        • et al.
        Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery.
        N Engl J Med. 2004; 351: 2581-2589
        • Van Calster B.
        • McLernon D.J.
        • van Smeden M.
        • Wynants L.
        • Steyerberg E.W.
        Topic Group ‘Evaluating diagnostic tests and prediction models’ of the STRATOS initiative. Calibration: the Achilles heel of predictive analytics.
        BMC Med. 2019; 17: 230
        • Kaimal A.J.
        • Grobman W.A.
        • Bryant A.
        • et al.
        The association of patient preferences and attitudes with trial of labor after cesarean.
        J Perinatol. 2019; 39: 1340-1348
        • McMahon M.J.
        • Luther E.R.
        • Bowes Jr., W.A.
        • Olshan A.F.
        Comparison of a trial of labor with an elective second cesarean section.
        N Engl J Med. 1996; 335: 689-695
        • Grobman W.A.
        • Lai Y.
        • Landon M.B.
        • et al.
        Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor?.
        Am J Obstet Gynecol. 2009; 200: 56.e1-56.e6
        • Mardy A.H.
        • Ananth C.V.
        • Grobman W.A.
        • Gyamfi-Bannerman C.
        A prediction model of vaginal birth after cesarean in the preterm period.
        Am J Obstet Gynecol. 2016; 215: 513.e1-513.e7
        • Macones G.A.
        • Cahill A.
        • Pare E.
        • et al.
        Obstetric outcomes in women with two prior cesarean deliveries: is vaginal birth after cesarean delivery a viable option?.
        Am J Obstet Gynecol. 2005; 192: 1223-1228
        • Ha T.K.
        • Rao R.R.
        • Maykin M.M.
        • Mei J.Y.
        • Havard A.L.
        • Gaw S.L.
        Vaginal birth after cesarean: does accuracy of predicted success change from prenatal intake to admission?.
        Am J Obstet Gynecol MFM. 2020; 2: 100094
        • Bryant A.S.
        • Washington S.
        • Kuppermann M.
        • Cheng Y.W.
        • Caughey A.B.
        Quality and equality in obstetric care: racial and ethnic differences in caesarean section delivery rates.
        Paediatr Perinat Epidemiol. 2009; 23: 454-462
        • Yee L.M.
        • Costantine M.M.
        • Rice M.M.
        • et al.
        Racial and ethnic differences in utilization of labor management strategies intended to reduce cesarean delivery rates.
        Obstet Gynecol. 2017; 130: 1285-1294