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Rao J, Fan D, Li P, Li Y, Hu P, Wu Z, He J, Liu X, Peng B, Guo X, Liu Z. Prediction of vaginal birth after cesarean in China. Int J Gynaecol Obstet 2023; 163:202-210. [PMID: 37096667 DOI: 10.1002/ijgo.14801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE This study aimed to develop and validate a prediction model of vaginal birth after cesarean delivery (VBAC) in China. METHODS A nomogram for effective prediction of VBAC of singleton, cephalic and one previous low-transverse cesarean section deliveries was created by comparing the combinations of ultrasonographic and non-ultrasonographic factors from five hospitals between 2018 and 2019. RESULTS A total of 1066 women were included. Of the women who underwent trial of labor after cesarean (TOLAC), 854 (80.1%) had a VBAC. Ultrasound factors included reached a higher area under the curve (AUC) combined with non-ultrasonographic factors. Of the three ultrasonographic factors analyzed, the best predictive factor for successful TOLAC was fetal abdominal circumference. A nomogram was generated with eight validated factors, including maternal age, gestational week, height, previous vaginal delivery, Bishop score, dilatation of the cervix at the time of admission, body mass index at delivery, and fetal abdominal circumference by ultrasound. The trained and validated AUC were 0.719 (95% confident interval 0.674-0.764) and 0.774 (95% confident interval 0.712-0.837), respectively. CONCLUSION Our VBAC nomogram based on obstetric factors and fetal abdominal circumference obtained by ultrasound could be used to counsel women who are considering TOLAC.
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Affiliation(s)
- Jiaming Rao
- Foshan Fetal Medicine Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, China
| | - Dazhi Fan
- Foshan Fetal Medicine Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, China
| | - Pengsheng Li
- Foshan Fetal Medicine Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, China
| | - Yiying Li
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, China
| | - Pengzhen Hu
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, China
| | - Zhaoxia Wu
- Department of Obstetrics, Nanhai Maternity & Child Healthcare Hospital, Foshan, Guangdong, China
| | - Jieyun He
- Department of Obstetrics, Shunde Maternity & Child Healthcare Hospital, Foshan, Guangdong, China
| | - Xinjuan Liu
- Department of Obstetrics, The People's Hospital of Gaoming, Foshan, Guangdong, China
| | - BingJie Peng
- Department of Obstetrics, Sanshui Maternity & Child Healthcare Hospital, Foshan, Guangdong, China
| | - Xiaoling Guo
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, China
| | - Zhengping Liu
- Foshan Fetal Medicine Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, China
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, China
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He X, Dai Q, Wu X, Zhou J, Li J. Outcomes and risk factors for failed trial of labor after cesarean delivery (TOLAC) in women with one previous cesarean section: a Chinese population-based study. BMC Pregnancy Childbirth 2022; 22:676. [PMID: 36057560 PMCID: PMC9440562 DOI: 10.1186/s12884-022-05005-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 08/26/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate the outcomes and risk factors for trial of labor after cesarean delivery (TOLAC) failure in patients in China. Methods Consecutive patients who had a previous cesarean delivery (CD) and attempted TOLAC were included from 2014 to 2020. Patients who successfully delivered were classified into the TOLAC success group. Patients who attempted TOLAC but had a repeat CD due to medical issues were classified into the TOLAC failure group. Multiple logistic regression analyses were performed to examine the risk factors for TOLAC failure. Results In total, 720 women who had a previous CD and attempted TOLAC were identified and included. The success rate of TOLAC was 84.2%(606/720). Seven patients were diagnosed with uterine rupture, none of whom underwent hysterectomy. Multiple logistic regression analysis showed that the induction of labor (OR = 2.843, 95% CI: 1.571–5.145, P < 0.001) was positively associated with TOLAC failure, but the thickness of the lower uterine segment (LUS) (OR = 0.215, 95% CI: 0.103–0.448, P < 0.001) was negatively associated with TOLAC failure. Conclusions This study suggested that TOLAC was effective in decreasing CD rates in the Chinese population. The induction of labor was positively associated with TOLAC failure, but the thickness of the LUS was negatively associated with TOLAC failure. Our findings need to be confirmed in larger samples with patients of different ethnicities.
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Affiliation(s)
- Xiaobo He
- Department of Obstetrics, Ningbo Women and Children's Hospital, Ningbo, 315012, Zhejiang, China
| | - Qiaona Dai
- Department of Obstetrics, Ningbo Women and Children's Hospital, Ningbo, 315012, Zhejiang, China
| | - Xiaoli Wu
- Department of Obstetrics, Ningbo Women and Children's Hospital, Ningbo, 315012, Zhejiang, China
| | - Junjun Zhou
- Department of Obstetrics, Ningbo Women and Children's Hospital, Ningbo, 315012, Zhejiang, China
| | - Jie Li
- Department of Obstetrics, Ningbo Women and Children's Hospital, Ningbo, 315012, Zhejiang, China.
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