Document Detail


Predicting failure of a vaginal birth attempt after cesarean delivery.
MedLine Citation:
PMID:  17400839     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To identify a group of clinical factors that could be used to accurately predict failure in women attempting vaginal birth after cesarean (VBAC). METHODS: We conducted a planned secondary analysis of a retrospective cohort study of women who were offered VBAC from 1996 to 2000 in 17 community and university hospitals. We collected information about maternal history and outcomes of the index pregnancy. We used univariable and multivariable statistical methods to develop a multivariable prediction model for the outcome of VBAC failure. RESULTS: A total of 13,706 patients attempted VBAC, with a failure rate of 24.5%. Six variables were significantly associated with VBAC failure in our final logistic regression model: gestational age at delivery, maternal age, maternal race, labor type (spontaneous, augmented, or induced), history of vaginal delivery, and cephalopelvic disproportion or failed induction (combined variable) as prior cesarean indication. The area under the receiver operating characteristics curve is 0.717. To achieve a sensitivity of approximately 75%, a false-positive rate of approximately 40% would result. CONCLUSION: Our results indicate that significant clinical variables (prelabor and labor) cannot reliably predict VBAC failure. LEVEL OF EVIDENCE: II.
Authors:
Sindhu K Srinivas; David M Stamilio; Erika J Stevens; Anthony O Odibo; Jeffrey F Peipert; George A Macones
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  109     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-04-02     Completed Date:  2007-04-26     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  800-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA. ssrinivas@obgyn.upenn.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Cohort Studies
Female
Forecasting
Gestational Age
Humans
Odds Ratio
Pregnancy
ROC Curve
Retrospective Studies
Trial of Labor*
Vaginal Birth after Cesarean / adverse effects,  contraindications*
Grant Support
ID/Acronym/Agency:
K24 HD 4537328/HD/NICHD NIH HHS; K24 HD01298/HD/NICHD NIH HHS; R01HD 35631/HD/NICHD NIH HHS
Comments/Corrections
Comment In:
Obstet Gynecol. 2007 Apr;109(4):796-7   [PMID:  17400837 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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