Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/86992
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Type: Journal article
Title: A clinical prediction model to assess the risk of operative delivery
Author: Schuit, E.
Kwee, A.
Westerhuis, M.
van Dessel, H.
Graziosi, G.
van Lith, J.
Nijhuis, J.
Oei, S.
Oosterbaan, H.
Schuitemaker, N.
Wouters, M.
Visser, G.
Mol, B.
Moons, K.
Groenwold, R.
Citation: BJOG, 2012; 119(8):915-923
Publisher: Wiley
Issue Date: 2012
ISSN: 1470-0328
1471-0528
Statement of
Responsibility: 
Schuit, A Kwee, MEMH Westerhuis, HJHM Van Dessel, GCM Graziosi, JMM Van Lith, JG Nijhuis, SG Oei, HP Oosterbaan, NWE Schuitemaker, MGAJ Wouters, GHA Visser, BWJ Mol, KGM Moons and RHH Groenwold
Abstract: Objective:  To predict instrumental vaginal delivery or caesarean section for suspected fetal distress or failure to progress. Design:  Secondary analysis of a randomised trial. Setting:  Three academic and six non-academic teaching hospitals in the Netherlands. Population:  5667 labouring women with a singleton term pregnancy in cephalic presentation. Methods:  We developed multinomial prediction models to assess the risk of operative delivery using both antepartum (model 1) and antepartum plus intrapartum characteristics (model 2). The models were validated by bootstrapping techniques and adjusted for overfitting. Predictive performance was assessed by calibration and discrimination (area under the receiver operating characteristic), and easy-to-use nomograms were developed. Main outcome measures:  Incidence of instrumental vaginal delivery or caesarean section for fetal distress or failure to progress with respect to a spontaneous vaginal delivery (reference). Results:  375 (6.6%) and 212 (3.6%) women had an instrumental vaginal delivery or caesarean section due to fetal distress, and 433 (7.6%) and 571 (10.1%) due to failure to progress, respectively. Predictors were age, parity, previous caesarean section, diabetes, gestational age, gender, estimated birthweight (model 1) and induction of labour, oxytocin augmentation, intrapartum fever, prolonged rupture of membranes, meconium stained amniotic fluid, epidural anaesthesia, and use of ST-analysis (model 2). Both models showed excellent calibration and the receiver operating characteristics areas were 0.70–0.78 and 0.73–0.81, respectively. Conclusion:  In Dutch women with a singleton term pregnancy in cephalic presentation, antepartum and intrapartum characteristics can assist in the prediction of the need for an instrumental vaginal delivery or caesarean section for fetal distress or failure to progress.
Keywords: Caesarean section; failure to progress; instrumental vaginal delivery; prognostic model; suspected fetal distress
Rights: © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG
RMID: 0020136672
DOI: 10.1111/j.1471-0528.2012.03334.x
Appears in Collections:Obstetrics and Gynaecology publications

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