Mode of birth after caesarean section: individual prediction scores using Scottish population data
Abstract Background Rising caesarean section (CS) rates are a global health concern. Contemporary data indicates that almost 50% of CS are electively performed, with a high proportion of these being a repeat procedure. Vaginal birth after caesarean (VBAC) is recognised as a safe way to give birth in...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-02-01
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| Series: | BMC Pregnancy and Childbirth |
| Online Access: | http://link.springer.com/article/10.1186/s12884-019-2226-6 |
| _version_ | 1818493775020818432 |
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| author | Sara Helen Denham Tracy Humphrey Claire deLabrusse Nadine Dougall |
| author_facet | Sara Helen Denham Tracy Humphrey Claire deLabrusse Nadine Dougall |
| author_sort | Sara Helen Denham |
| collection | DOAJ |
| description | Abstract Background Rising caesarean section (CS) rates are a global health concern. Contemporary data indicates that almost 50% of CS are electively performed, with a high proportion of these being a repeat procedure. Vaginal birth after caesarean (VBAC) is recognised as a safe way to give birth in developed countries. UK national maternity policy and worldwide professional guidance supports shared decision-making about mode of birth with women following CS. Evidence suggests that women want individualised information, particularly about their likeilihood of successful VBAC, to enable them to participate in the decision making process. This study aimed to identify characteristics that could inform a predictive model which would allow women to receive personalised and clinically specific information about their likelihood of achieving a successful VBAC in subsequent pregnancies. Methods An observational study using anonymised clinical data extracted from a detailed, comprehensive socio-demographic and clinical dataset. All women who attempted a singleton term VBAC between 2000 and 2012 were included. Data were analysed using both logistic regression and Bayesian statistical techniques to identify clinical and demographic variables predictive of successful VBAC. Results Variables significantly associated with VBAC were: ethnicity (p = 0.011), maternal obstetric complications (p < 0.001), previous vaginal birth (p = < 0.001), antepartum haemorrhage (p = 0.005), pre-pregnancy BMI (p < 0.001) and a previous second stage CS (p < 0.001). Conclusions By using current literature, expert clinical opinion and having access to clinically detailed variables, this study has identified a new significant characteristic. Women who had a previous CS in the second stage of labour are more likely to have a successful VBAC. This predictor may have international significance for women and clinicians in shared VBAC decision-making. Further research is planned to validate this model on a larger national sample leading to further development of the nomogram tool developed in this study for use in clinical practice to assist women and clinicians in the decision-making process about mode of birth after CS. |
| first_indexed | 2024-12-10T17:58:25Z |
| format | Article |
| id | doaj.art-7ad1785e64274fcc907e066bbfa8477e |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-10T17:58:25Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-7ad1785e64274fcc907e066bbfa8477e2022-12-22T01:38:52ZengBMCBMC Pregnancy and Childbirth1471-23932019-02-011911910.1186/s12884-019-2226-6Mode of birth after caesarean section: individual prediction scores using Scottish population dataSara Helen Denham0Tracy Humphrey1Claire deLabrusse2Nadine Dougall3School of Health and Social Care, Edinburgh Napier University, Sighthill CampusSchool of Health and Social Care, Edinburgh Napier University, Sighthill CampusSchool of Health Sciences (HESAV) Midwifery Department, University of Applied Sciences and Arts Western SwitzerlandSchool of Health and Social Care, Edinburgh Napier University, Sighthill CampusAbstract Background Rising caesarean section (CS) rates are a global health concern. Contemporary data indicates that almost 50% of CS are electively performed, with a high proportion of these being a repeat procedure. Vaginal birth after caesarean (VBAC) is recognised as a safe way to give birth in developed countries. UK national maternity policy and worldwide professional guidance supports shared decision-making about mode of birth with women following CS. Evidence suggests that women want individualised information, particularly about their likeilihood of successful VBAC, to enable them to participate in the decision making process. This study aimed to identify characteristics that could inform a predictive model which would allow women to receive personalised and clinically specific information about their likelihood of achieving a successful VBAC in subsequent pregnancies. Methods An observational study using anonymised clinical data extracted from a detailed, comprehensive socio-demographic and clinical dataset. All women who attempted a singleton term VBAC between 2000 and 2012 were included. Data were analysed using both logistic regression and Bayesian statistical techniques to identify clinical and demographic variables predictive of successful VBAC. Results Variables significantly associated with VBAC were: ethnicity (p = 0.011), maternal obstetric complications (p < 0.001), previous vaginal birth (p = < 0.001), antepartum haemorrhage (p = 0.005), pre-pregnancy BMI (p < 0.001) and a previous second stage CS (p < 0.001). Conclusions By using current literature, expert clinical opinion and having access to clinically detailed variables, this study has identified a new significant characteristic. Women who had a previous CS in the second stage of labour are more likely to have a successful VBAC. This predictor may have international significance for women and clinicians in shared VBAC decision-making. Further research is planned to validate this model on a larger national sample leading to further development of the nomogram tool developed in this study for use in clinical practice to assist women and clinicians in the decision-making process about mode of birth after CS.http://link.springer.com/article/10.1186/s12884-019-2226-6 |
| spellingShingle | Sara Helen Denham Tracy Humphrey Claire deLabrusse Nadine Dougall Mode of birth after caesarean section: individual prediction scores using Scottish population data BMC Pregnancy and Childbirth |
| title | Mode of birth after caesarean section: individual prediction scores using Scottish population data |
| title_full | Mode of birth after caesarean section: individual prediction scores using Scottish population data |
| title_fullStr | Mode of birth after caesarean section: individual prediction scores using Scottish population data |
| title_full_unstemmed | Mode of birth after caesarean section: individual prediction scores using Scottish population data |
| title_short | Mode of birth after caesarean section: individual prediction scores using Scottish population data |
| title_sort | mode of birth after caesarean section individual prediction scores using scottish population data |
| url | http://link.springer.com/article/10.1186/s12884-019-2226-6 |
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