Prognostic models in obstetrics: available, but far from applicable

Abstract

Health care provision is increasingly focused on the prediction of patients' individual risk for developing a particular health outcome in planning further tests and treatments. There has been a steady increase in the development and publication of prognostic models for various maternal and fetal outcomes in obstetrics. We undertook a systematic review to give an overview of the current status of available prognostic models in obstetrics in the context of their potential advantages and the process of developing and validating models. Important aspects to consider when assessing a prognostic model are discussed and recommendations on how to proceed on this within the obstetric domain are given. We searched MEDLINE (up to July 2012) for articles developing prognostic models in obstetrics. We identified 177 papers that reported the development of 263 prognostic models for 40 different outcomes. The most frequently predicted outcomes were preeclampsia (n = 69), preterm delivery (n = 63), mode of delivery (n = 22), gestational hypertension (n = 11), and small-for-gestational-age infants (n = 10). The performance of newer models was generally not better than that of older models predicting the same outcome. The most important measures of predictive accuracy (ie, a model's discrimination and calibration) were often (82.9%, 218/263) not both assessed. Very few developed models were validated in data other than the development data (8.7%, 23/263). Only two-thirds of the papers (62.4%, 164/263) presented the model such that validation in other populations was possible, and the clinical applicability was discussed in only 11.0% (29/263). The impact of developed models on clinical practice was unknown. We identified a large number of prognostic models in obstetrics, but there is relatively little evidence about their performance, impact, and usefulness in clinical practice so that at this point, clinical implementation cannot be recommended. New efforts should be directed toward evaluating the performance and impact of the existing models.

Validation of Reference Charts for Mid-Trimester Fetal Biometry

“…To calculate individual risks, prognostic models have been developed for various maternal and fetal outcomes [1]. Fetal size is an important predictor in several models, since both small and large for gestational age fetuses are at increased risk of perinatal mortality and morbidity [2, 3].…”

External Validation and Clinical Usefulness of First Trimester Prediction Models for the Risk of Preeclampsia: A Prospective Cohort Study

“…The model of Kenny et al [18] stayed most stable in our external validation cohort. External validation studies of prediction models for PE are scarce [13,14,39,40]. None have simultaneously considered all first trimester prediction models based on routinely collected maternal characteristics for the risk of PE.…”

“…The paper of Syngelaki et al [20], included on the basis of citation lists, was not selected from our systematic search as the title and abstract did not clearly indicate that it addressed prediction models for a wide range of adverse pregnancy outcomes. Syngelaki's model was also not described in existing systematic reviews about prediction models for PE [13,14,39,49]. A limitation in the selection process is that we had to exclude a substantial proportion of prediction models as the algorithm was not available, even after contacting the authors.…”

External validation, update and development of prediction models for pre-eclampsia using an Individual Participant Data (IPD) meta-analysis: the International Prediction of Pregnancy Complication Network (IPPIC pre-eclampsia) protocol

“…We will also update our systematic review of prediction models for preeclampsia [35] Internet searches will also be carried out using specialist search gateways, general search engines (such as Google: http://www.google.co.uk/) and meta-search engines (such as Copernic: http://www.copernic.com/). Language restrictions will not be applied to the electronic searches.…”