Risk Calculator to Predict Cesarean Delivery Among Women Undergoing Induction of Labor

Abstract

OBJECTIVE: To develop and validate a predictive risk calculator for cesarean delivery among women undergoing induction of labor. METHODS: We performed a population-based cohort study of all women who had singleton live births after undergoing induction of labor from 32 0/7 to 42 6/7 weeks of gestation in the United States from 2012 to 2016. The primary objective was to build a predictive model estimating the probability of cesarean delivery after induction of labor using antenatal factors obtained from de-identified U.S. live-birth records. Multivariable logistic regression estimated the association of these factors on risk of cesarean delivery. K-fold cross validation was performed for internal validation of the model, followed by external validation using a separate live-birth cohort from 2017. A publicly available online calculator was developed after validation and calibration were performed for individual risk assessment. The seven variables selected for inclusion in the model by magnitude of influence were prior vaginal delivery, maternal weight at delivery, maternal height, maternal age, prior cesarean delivery, gestational age at induction, and maternal race. RESULTS: From 2012 to 2016, there were 19,844,580 live births in the United States, of which 4,177,644 women with singleton gestations underwent induction of labor. Among these women, 800,423 (19.2%) delivered by cesarean. The receiver operating characteristic curve for the seven-variable model achieved an area under the curve (AUC) of 0.787 (95% CI 0.786–0.788). External validation demonstrated a consistent measure of discrimination with an AUC of 0.783 (95% CI 0.764–0.802). CONCLUSION: This validated predictive model uses seven variables that were obtainable from the patient's medical record and discriminates between women at increased or decreased risk of cesarean delivery after induction of labor. This risk calculator, found at https://ob.tools/iol-calc, can be used in addition to the Bishop score by health care providers in counseling women who are undergoing an induction of labor and allocating appropriate resources for women at high risk for cesarean delivery.

Development And Validation Of Models To Predict Cesarean Delivery Among Low-Risk Nulliparous Women At Term: A Retrospective Study In China

“…The AUC ROC in the derivation set and internal validation set were 0.76 and 0.74, respectively. Rossi et al [12] developed and validated a predictive risk calculator for cesarean among women undergoing induction of labor. Seven independent risk factors had been associated with an increased risk The formula used a nomogram to calculate the probability of cesarean (Figure 4).…”

“…The candidate predictor variables had to be easily accessible through characteristics' data. To identify predictor variables, a systematic review of the literature was conducted [8][9][10][11][12][14][15][16]. The following variables were recorded: maternal age, height, weight, baseline body mass index (BMI), weight change during pregnancy, gestational age at delivery, premature rupture of membranes (PROM), epidural analgesia, meconium-stained amniotic uid, induction methods(oxytocin, amniotomy, disposable cervical dilator balloon, prostaglandin(Propess or Misoprostol)), neonatal sex, and neonatal birth weight.…”

“…Currently, several published models studied on prediction of cesarean delivery were mostly focused on the white populations [8][9][10][11][12], whereas the data of the majority of Han ethnic backgrounds of the Chinese population are insu cient. To date, China lacks the relevant researches, and there is limited empirical evidence and clinical experience reported.…”

A Model to Predict Vaginal Delivery and Maternal and Neonatal Morbidity in Low-Risk Nulliparous Patients at Term

“…Other nomograms to predict VD have been published, and some variables that we identified as associated with VD in this study (e.g., cervical exam and BMI) have been previously reported. [17][18][19][20][21][22][23] Eggebø et al reported a model to predict VD in nulliparous patients using maternal characteristics (age, BMI, GA, prolonged labor, and cervical dilatation) and intrapartum ultrasound parameters (head-perineum distance, presence of succedaneum, and fetal position). 17 While other models were developed to predict mode of delivery in patients specifically undergoing induction of labor, [18][19][20] or included additional factors such as the presence of comorbidities (e.g., hypertension, diabetes, and abruption), 18,20 our analysis differs in that we only included nulliparous low-risk patients who did not have any other comorbidities.…”

Development and validation of models to predict cesarean delivery among low-risk nulliparous women at term: a retrospective study in China

“…Currently, several published models studied on prediction of cesarean delivery were mostly focused on the white populations [7,[11][12][13][14], whereas the data of the majority of Han ethnic backgrounds of the Chinese population are insu cient. To date, China lacks the relevant researches, and there is limited empirical evidence and clinical experience reported.…”