A clinical prediction model to assess the risk of operative delivery

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 STanalysis (model 2). Both models showed excellent calibration and the receiver operating characteristics areas were 0.70-0.78 and 0.73-0.81, respectively. ConclusionIn 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.

The association between attendance of midwives and workload of midwives with the mode of birth: secondary analyses in the German healthcare system

“…Consistent with previous research, the use of epidurals and opiates and the time span between admission and birth were positively related to the likelihood of caesarean and operative delivery [23, 32, 34–38]. …”

“…Although the literature are inconsistent with respect to the usage of oxytocin and its effect on the mode of birth [32, 39–41], we observed a negative relationship between the likelihood of spontaneous birth and the usage of this hormone. Oxytocin usage in Germany is common if dystocia or bradytocia occurs and is used to a lesser degree for active management during labour.…”

Is fetal cerebroplacental ratio an independent predictor of intrapartum fetal compromise and neonatal unit admission?

“…These findings are consistent with a recent study, where the investigators developed a clinical prediction model to assess the risk of operative delivery for suspected fetal distress or failure to progress, using data from 5667 singleton pregnancies. 32 Importantly, in our study cohort, CPR had the strongest association with adverse labor outcomes among all the antenatally determinable characteristics. The association between BW centiles and admission to the NNU at term was not significant.…”

Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: a prospective cohort study

“…Parity is known to be associated with the birth process, which was confirmed in the present study. 8 10 11 The different effect of anxiety on interventions in the birth process in nulliparae and multiparae can be explained by physiological factors, by the woman's experience during the previous labour, resulting in more anxiety in women with a complicated previous labour, and also by the information available for the care provider on the previous birth process. The increased risk for induction of labour in multiparae with high general anxiety may be due to greater confidence by obstetric caregivers that the induction will be successful in multiparae.…”

“…[4][5][6][7] The progression of the birth process and concomitant interventions are associated with maternal characteristics such as age, parity, body mass index (BMI), ethnicity, illness and infant birth weight, as well as with organisational factors such as existing guidelines, the availability of 24 hours pain relief, the profession of the obstetric care provider (midwife vs physician) and the level of care (primary/secondary). [8][9][10][11][12] Moreover, maternal anxiety might play a role in the birth process. Although one review found no overall association between anxiety and obstetric complications, specific types of anxiety (such as fear of childbirth) may be Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: a prospective cohort study Johanna Maria Koelewijn, 1,2 Anne Marie Sluijs, 3 Open Access associated with specific complications and interventions, such as prolonged labour and caesarean section.…”