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. 2020 Mar;135(3):559-568.
doi: 10.1097/AOG.0000000000003696.

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

Robert M Rossi  1 , Erin Requarth, Carri R Warshak, Kevin R Dufendach, Eric S Hall, Emily A DeFranco
Affiliations

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

Robert M Rossi et al. Obstet Gynecol. 2020 Mar.

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.

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References

    1. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2017. Natl Vital Stat Rep 2018;67:1–50.
    1. Grobman WA, Rice MM, Reddy UM, Tita ATN, Silver RM, Mallett G, et al. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med 2018;379:513–23.
    1. American College of Obstetricians and Gynecologists. Practice advisory: clinical guidance for integration of the findings of the ARRIVE trial: labor induction versus expectant management in low-risk nulliparous women. Available at: https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisor.... Retrieved September 1, 2019.
    1. Sotiriadis A, Petousis S, Thilaganathan B, Figueras F, Martins WP, Odibo AO, et al. Maternal and perinatal outcomes after elective induction of labor at 39 weeks in uncomplicated singleton pregnancy: a meta-analysis. Ultrasound Obstet Gynecol 2019;53:26–35.
    1. Levine LD, Downes KL, Parry S, Elovitz MA, Sammel MD, Srinivas SK. A validated calculator to estimate risk of cesarean after an induction of labor with an unfavorable cervix. Am J Obstet Gynecol 2018;218:254.e1–7.

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