Validated Calculators Predicting Cesarean Delivery After Induction: Accuracy in an External Population.
Journal
Obstetrics and gynecology
ISSN: 1873-233X
Titre abrégé: Obstet Gynecol
Pays: United States
ID NLM: 0401101
Informations de publication
Date de publication:
01 Jul 2023
01 Jul 2023
Historique:
received:
11
02
2023
accepted:
07
04
2023
medline:
26
6
2023
pubmed:
8
6
2023
entrez:
8
6
2023
Statut:
ppublish
Résumé
To evaluate the performance of two previously published calculators in predicting cesarean delivery after induction of labor in an external population. This was a cohort study including all nulliparous pregnant patients with singleton, term, vertex fetuses; intact membranes; and unfavorable cervices who underwent induction of labor between 2015 and 2017 at an academic tertiary care institution. Individual predicted cesarean risk scores were calculated with two previously published calculators. For each calculator, patients were stratified into three risk groups (lower, middle, and upper thirds) of approximately equivalent size. Predicted and observed incidences of cesarean delivery were compared with two-tailed binomial tests of probability in the overall population and in each risk group. A total of 846 patients met inclusion criteria, and 262 (31.0%) had cesarean deliveries, which was significantly lower than overall predicted rates of 40.0% and 36.2% with the two calculators (both P <.01). Both calculators significantly overestimated risk of cesarean delivery in higher risk tertiles (all P <.05). The areas under the receiver operating characteristic for both calculators were 0.57 or less in the overall population and in each risk group, suggesting poor predictive value. Higher predicted risk tertile in both calculators was not associated with any maternal or neonatal outcomes except wound infection. Both previously published calculators had poor performance in this population, with neither calculator accurately predicting the incidence of cesarean delivery. Patients and health care professionals might be discouraged regarding trial of labor induction by falsely high predicted risk-of-cesarean scores. We caution against widespread implementation of these calculators without further population-specific refinement and adjustment.
Identifiants
pubmed: 37290103
doi: 10.1097/AOG.0000000000005234
pii: 00006250-202307000-00012
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
99-107Informations de copyright
Copyright © 2023 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Financial Disclosure Adam K. Lewkowitz reports receiving payment from Shield Pharmaceuticals and Pharmacosmos Therapeutics, Inc. Stephanie L. Gaw's institution received payment from the National Institutes of Health, Bill and Melinda Gates Foundation, Robert Wood Johnson Foundation, and the CDC Foundation. The other authors did not report any potential conflicts of interest.
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