Development of a Nomogram for Prediction of Vaginal Birth after Cesarean Delivery

Citation

Grobman, William A.; Lai, Yinglei; Landon, Mark B.; Spong, Catherine Y.; Leveno, Kenneth J.; Rouse, Dwight J.; Varner, Michael W.; Moawad, Atef H.; Caritis, Steve N.; & Harper, Margaret A., et al. (2007). Development of a Nomogram for Prediction of Vaginal Birth after Cesarean Delivery. Obstetrics & Gynecology, 109(4), 806-812.

Abstract

OBJECTIVE: To develop a model based on factors available at the first prenatal visit that predicts chance of successful vaginal birth after cesarean delivery (VBAC) for individual patients who undergo a trial of labor.
METHODS: All women with one prior low transverse cesarean who underwent a trial of labor at term with a vertex singleton gestation were identified from a concurrently collected database of deliveries at 19 academic centers during a 4-year period. Using factors identifiable at the first prenatal visit, we analyzed different classification techniques in an effort to develop a meaningful prediction model for VBAC success. After development and cross-validation, this model was represented by a graphic nomogram.
RESULTS: Seven-thousand six hundred sixty women were available for analysis. The prediction model is based on a multivariable logistic regression, including the variables of maternal age, body mass index, ethnicity, prior vaginal delivery, the occurrence of a VBAC, and a potentially recurrent indication for the cesarean delivery. After analyzing the model with cross-validation techniques, it was found to be both accurate and discriminating.
CONCLUSION: A predictive nomogram, which incorporates six variables easily ascertainable at the first prenatal visit, has been developed that allows the determination of a patient-specific chance for successful VBAC for those women who undertake trial of labor.

URL

http://dx.doi.org/10.1097/01.AOG.0000259312.36053.02

Reference Type

Journal Article

Year Published

2007

Journal Title

Obstetrics & Gynecology

Author(s)

Grobman, William A.
Lai, Yinglei
Landon, Mark B.
Spong, Catherine Y.
Leveno, Kenneth J.
Rouse, Dwight J.
Varner, Michael W.
Moawad, Atef H.
Caritis, Steve N.
Harper, Margaret A.
Wapner, Ronald J.
Sorokin, Yoram
Miodovnik, Menachem
Carpenter, Marshall W.
O'Sullivan, Mary Jo
Sibai, Baha M.
Langer, Oded
Thorp, John M., Jr.
Ramin, Susan M.
Mercer, Brian M., for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network

ORCiD

Thorp - 0000-0002-9307-6690