A model to predict vaginal delivery in nulliparous women based on maternal characteristics and intrapartum ultrasound - 31/08/15
Abstract |
Objective |
Accurate prediction of whether a nulliparous woman will have a vaginal delivery would be a major advance in obstetrics. The objective of the study was to develop such a model based on maternal characteristics and the results of intrapartum ultrasound.
Study Design |
One hundred twenty-two nulliparous women in the first stage of labor were included in a prospective observational 2-centre study. Labor was classified as prolonged according to the respective countries’ national guidelines. Fetal head position was assessed with transabdominal ultrasound and cervical dilatation by digital examination, and transperineal ultrasound was used to determine head-perineum distance and the presence of caput succedaneum. The subjects were divided into a testing set (n = 61) and a validation set (n = 61) and a risk score derived using multivariable logistic regression with vaginal birth as the outcome, which was dichotomized into no/cesarean delivery and yes/vaginal birth. Covariates included head-perineum distance, caput succedaneum, and occiput posterior position, which were dichotomized respectively into the following: ≤40 mm, >40 mm, <10 mm, ≥10 mm, and no, yes. Maternal age, gestational age, and maternal body mass index were included as continuous covariates.
Results |
Dichotomized score is significantly associated with vaginal delivery (P = .03). Women with a score above the median had greater than 10 times the odds of having a vaginal delivery as compared with those with a score below the median. The receiver-operating characteristic curve showed an area under the curve of 0.853 (95% confidence interval, 0.678–1.000).
Conclusion |
A risk score based on maternal characteristics and intrapartum findings can predict vaginal delivery in nulliparous women in the first stage of labor.
Le texte complet de cet article est disponible en PDF.Key words : cesarean delivery, head-perineum distance, prediction model, transperineal
Plan
| The views expressed are those of the author(s) and not necessarily those of the National Health Service, the National Institute for Health Research, the British Medical Association, or the Department of Health. |
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| The Helen Lawson Grant, funded by the British Medical Association, has supported S.U.; C.C.L. is supported by the National Institute for Health Research Biomedical Research Centre, based at Imperial College Healthcare National Health Service Trust and Imperial College London. |
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| The authors report no conflict of interest. |
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| Cite this article as: Eggebø TM, Wilhelm-Benartzi C, Hassan WA, et al. A model to predict vaginal delivery in nulliparous women based on maternal characteristics and intrapartum ultrasound. Am J Obstet Gynecol 2015;213:362.e1-6. |
Vol 213 - N° 3
P. 362.e1-362.e6 - septembre 2015 Retour au numéro
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