Abstract
There is an urgent need in China to better predict vaginal birth after cesarean (VBAC) to face the challenge of the second child policy. We aimed to validate a widely used VBAC prediction model (Grobman’s model) and a modified version of this model in a Chinese population. In this retrospective cohort study, 444 women with one cesarean delivery and at least one subsequent attempt for a trial of labor in Nanjing, China were included. The considered potential VBAC predictors included Grobman’s background variables and five new variables. Overall, a total of 370 women had VBAC, with a success rate of 83.3%. The new background variables “maternal height” and “estimated fetal weight” were considered as two additional predictors for VBAC. The AUC of Grobman’s model was 0.831 (95%CI = 0.775–0.886) while the AUC of our modified model with two new variables added was 0.857 (sensitivity = 72.2%, specificity = 83.8%). However, the difference between the AUC of the two models was not significant (Z = −1.69, P = 0.091). We confirmed that Grobman’s model was accepted in the Chinese population. A modified model that is supplemented with maternal height and estimated fetal weight needs to be further studied in the Chinese population.
Highlights
The cesarean delivery (CD) rate has increased substantially over recent decades
4,860 women had a history of CD, and only 452 women tried vaginal birth after cesarean (VBAC); the rate of trial of labor after cesarean delivery (TOLAC) was 9.3%
There were no significant differences in the distribution of maternal age, maternal residence, any prior vaginal delivery, vaginal delivery after prior cesarean, interval time from prior cesarean, perinatal care registration, or labor analgesia rate between the successful and failed TOLAC groups
Summary
The cesarean delivery (CD) rate has increased substantially over recent decades. It is estimated that almost a third of women have delivered by CD worldwide[1,2]. Variable Maternal age (years) Maternal residence Nanjing of Jiangsu province Other cities of Jiangsu province Other provinces Gravidity Parity Recurring indication for cesarean Any prior vaginal delivery Vaginal delivery after prior cesarean BMI at last prenatal visit (kg/m2) EGA at delivery (weeks) Preeclampsia Cervical effacement at admission (10%) Cervical dilation at admission (cm) Station at admission (fifths scale) Induction of labor Maternal height Estimated fetal weight Interval time from prior cesarean (months) Perinatal care registration Labor analgesia Indications for the previous CD Social factors Malpresentation Macrosomia Abnormal labor stages Fetal distress Amniotic fluid volume abnormality Prolonged pregnancy, ≥42 weeks Severe pregnancy complications or maternal disease Cord around neck, ≥3 cycles. VBAC prediction models would be useful in clinical practice
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