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      Simple, Validated Vaginal Birth After Cesarean Delivery Prediction Model for Use at the Time of Admission

      research-article
      , MD, MS, , MPH, , MPH, , MD, , MD, , MD
      Obstetrics and gynecology

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          Abstract

          OBJECTIVE

          To create a simple tool for predicting the likelihood of successful trial of labor after cesarean delivery (TOLAC) during the pregnancy after a primary cesarean delivery using variables available at the time of admission.

          METHODS

          Data for all deliveries at 14 regional hospitals over an 8-year period were reviewed. Women with one cesarean delivery and one subsequent delivery were included. Variables associated with successful VBAC were identified using multivariable logistic regression. Points were assigned to these characteristics, with weighting based on the coefficients in the regression model to calculate an integer VBAC score. The VBAC score was correlated with TOLAC success rate and was externally validated in an independent cohort using a logistic regression model.

          RESULTS

          A total of 5,445 women met inclusion criteria. Of those women, 1,170 (21.5%) underwent TOLAC. Of the women who underwent trial of labor, 938 (80%) had a successful VBAC. AVBAC score was generated based on the Bishop score (cervical examination) at the time of admission, with points added for history of vaginal birth, age younger than 35 years, absence of recurrent indication, and body mass index less than 30. Women with a VBAC score less than 10 had a likelihood of TOLAC success less than 50%. Women with a VBAC score more than 16 had a TOLAC success rate more than 85%. The model performed well in an independent cohort with an area under the curve of 0.80 (95% confidence interval 0.76–0.84).

          CONCLUSIONS

          Prediction of TOLAC success at the time of admission is highly dependent on the initial cervical examination. This simple VBAC score can be utilized when counseling women considering TOLAC.

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          Author and article information

          Journal
          0401101
          6204
          Obstet Gynecol
          Obstet Gynecol
          Obstetrics and gynecology
          0029-7844
          1873-233X
          12 January 2017
          September 2013
          26 January 2017
          : 122
          : 3
          : 571-578
          Affiliations
          Department of Obstetrics and Gynecology and Study Design and Biostatistics Center, University of Utah, and the Institute for Healthcare Delivery Research and the Department of Maternal-Fetal Medicine, Intermountain Healthcare, Salt Lake City, Utah; and the Departments of Obstetrics and Gynecology, University of Colorado Denver, Aurora, and Denver Health Medical Center, Denver, Colorado
          Author notes
          Corresponding author: Torri Metz, MD, Department of Obstetrics and Gynecology, Denver Health Medical Center, 777 Bannock Street, MC 0660, Denver, CO 80204; torri.metz@ 123456dhha.org
          Article
          PMC5269128 PMC5269128 5269128 nihpa841653
          10.1097/AOG.0b013e31829f8ced
          5269128
          23921867
          92135da7-e5b9-405e-b79f-fb9f5a107eac
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