Predictive model for risk of cesarean section in pregnant women after induction of labor
Por:
Hernández-Martínez A, Pascual-Pedreño AI, Baño-Garnés AB, Melero-Jiménez MR, Tenías-Burillo JM and Molina-Alarcón M
Publicada:
1 mar 2016
Resumen:
Purpose To develop a predictive model for risk of cesarean section in
pregnant women after induction of labor.
Methods A retrospective cohort study was conducted of 861 induced labors
during 2009, 2010, and 2011 at Hospital "La Mancha-Centro" in Alcazar de
San Juan, Spain. Multivariate analysis was used with binary logistic
regression and areas under the ROC curves to determine predictive
ability. Two predictive models were created: model A predicts the
outcome at the time the woman is admitted to the hospital (before the
decision to of the method of induction); and model B predicts the
outcome at the time the woman is definitely admitted to the labor room.
Results The predictive factors in the final model were: maternal height,
body mass index, nulliparity, Bishop score, gestational age, macrosomia,
gender of fetus, and the gynecologist's overall cesarean section rate.
The predictive ability of model A was 0.77 [95 % confidence interval
(CI) 0.73-0.80] and model B was 0.79 (95 % CI 0.76-0.83). The predictive
ability for pregnant women with previous cesarean section with model A
was 0.79 (95 % CI 0.64-0.94) and with model B was 0.80 (95 % CI
0.64-0.96). For a probability of estimated cesarean section >= 80 %, the
models A and B presented a positive likelihood ratio (+LR) for cesarean
section of 22 and 20, respectively. Also, for a likelihood of estimated
cesarean section <= 10 %, the models A and B presented a +LR for vaginal
delivery of 13 and 6, respectively.
Conclusion These predictive models have a good discriminative ability,
both overall and for all subgroups studied. This tool can be useful in
clinical practice, especially for pregnant women with previous cesarean
section and diabetes.
Filiaciones:
Hernández-Martínez A:
"Mancha-Centro" Teaching Unit, Ciudad Real, Spain.
, C/Gerona 25 Tomelloso, 13700, Ciudad Real, Spain.
Pascual-Pedreño AI:
Gynecology and Obstetrics Department at Hospital "Mancha-Centro", Ciudad Real, Spain
Baño-Garnés AB:
Hospital "Mancha-Centro", Ciudad Real, Spain
Melero-Jiménez MR:
Hospital "Mancha-Centro", Ciudad Real, Spain
:
Public Health, Ciudad Real, Spain
Molina-Alarcón M:
University of Castilla-La Mancha, Ciudad Real, Spain
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