Externally Validated Prediction Model of Vaginal Delivery After Preterm Induction With Unfavorable Cervix.

MedStar author(s):
Citation: Obstetrics & Gynecology. 136(4):716-724, 2020 10.PMID: 32925613Institution: MedStar Health Research Institute | MedStar Washington Hospital Center | MedStar Washington Hospital Center C | SiTELDepartment: Obstetrics and Gynecology/Female Pelvic Medicine and Reconstructive Surgery | Obstetrics and Gynecology/Maternal-Fetal MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Clinical Decision Rules | *Delivery, Obstetric/mt [Methods] | *Labor Stage, First | *Labor, Induced/mt [Methods] | *Obstetric Labor, Premature | Adult | Comorbidity | Delivery, Obstetric/sn [Statistics & Numerical Data] | Female | Gestational Age | Humans | Infant, Newborn | Labor, Induced/sn [Statistics & Numerical Data] | Male | Mobile Applications | Pregnancy | Pregnancy Outcome/ep [Epidemiology] | Reproducibility of Results | Retrospective Studies | Risk Assessment/mt [Methods] | Risk FactorsYear: 2020Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0029-7844
Name of journal: Obstetrics and gynecologyAbstract: CONCLUSION: Our externally validated model was efficient in predicting vaginal delivery after preterm induction with unfavorable cervix.METHODS: This was a retrospective cohort study of women with a singleton gestation from a single academic institution who underwent an induction of labor at less than 37 weeks of gestation from January 2009 to June 2018. Women with contraindications for vaginal delivery were excluded. Analyses were limited to women with unfavorable cervix (both simplified Bishop score [dilation, station, and effacement: range 0-9] less than 6 and cervical dilation less than 3 cm). A stepwise logistic regression analysis was used to identify the factors associated with vaginal delivery by considering maternal characteristics and comorbidities as well as fetal conditions. The final model was validated using an external data set of the Consortium on Safe Labor after applying the same inclusion and exclusion criteria. We compared the area under the curve (AUC) of our predictive model and the simplified Bishop score.OBJECTIVE: To create and externally validate a predictive model to calculate the likelihood of vaginal delivery after preterm induction with unfavorable cervix.RESULTS: Of the 835 women, 563 (67%) had vaginal delivery. Factors associated with vaginal delivery included later gestational age at delivery, higher parity, more favorable simplified Bishop score, and preterm prelabor rupture of membranes. Factors including older maternal age, non-Hispanic Black race, higher body mass index, and abruption were associated with decreased likelihood of vaginal delivery. In the external validation cohort, 1,899 women were analyzed, of whom 1,417 (75%) had vaginal delivery. The AUCs of simplified Bishop score and the final model were 0.65 (95% CI 0.59-0.66) and 0.73 (95% CI 0.72-0.79), respectively, for the external validation cohort. The online calculator was created and is available at www.medstarapps.org/obstetricriskcalculator/ and in the Obstetric Risk Calculator mobile application in the Apple App Store and Google Play Store.All authors: Auguste TC, Bauer D, Huang JC, Kawakita T, Overcash RT, Reddy UMOriginally published: Obstetrics & Gynecology. 136(4):716-724, 2020 Oct.Fiscal year: FY2021Digital Object Identifier: Date added to catalog: 2020-10-06
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 32925613 Available 32925613

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

CONCLUSION: Our externally validated model was efficient in predicting vaginal delivery after preterm induction with unfavorable cervix.

METHODS: This was a retrospective cohort study of women with a singleton gestation from a single academic institution who underwent an induction of labor at less than 37 weeks of gestation from January 2009 to June 2018. Women with contraindications for vaginal delivery were excluded. Analyses were limited to women with unfavorable cervix (both simplified Bishop score [dilation, station, and effacement: range 0-9] less than 6 and cervical dilation less than 3 cm). A stepwise logistic regression analysis was used to identify the factors associated with vaginal delivery by considering maternal characteristics and comorbidities as well as fetal conditions. The final model was validated using an external data set of the Consortium on Safe Labor after applying the same inclusion and exclusion criteria. We compared the area under the curve (AUC) of our predictive model and the simplified Bishop score.

OBJECTIVE: To create and externally validate a predictive model to calculate the likelihood of vaginal delivery after preterm induction with unfavorable cervix.

RESULTS: Of the 835 women, 563 (67%) had vaginal delivery. Factors associated with vaginal delivery included later gestational age at delivery, higher parity, more favorable simplified Bishop score, and preterm prelabor rupture of membranes. Factors including older maternal age, non-Hispanic Black race, higher body mass index, and abruption were associated with decreased likelihood of vaginal delivery. In the external validation cohort, 1,899 women were analyzed, of whom 1,417 (75%) had vaginal delivery. The AUCs of simplified Bishop score and the final model were 0.65 (95% CI 0.59-0.66) and 0.73 (95% CI 0.72-0.79), respectively, for the external validation cohort. The online calculator was created and is available at www.medstarapps.org/obstetricriskcalculator/ and in the Obstetric Risk Calculator mobile application in the Apple App Store and Google Play Store.

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