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Prediction of vaginal birth after cesarean delivery in term gestations: A calculator without race and ethnicity

American Journal of Obstetrics and Gynecology Jun 17, 2021

Grobman WA, Sandoval G, Rice MM, et al. - Researchers aimed at developing a tool that could aid in accurately predicting vaginal birth after cesarean delivery, using easily retrievable data in early pregnancy, without the inclusion of race and ethnicity. They conducted a secondary analysis of the Cesarean Registry of the Maternal-Fetal Medicine Units Network. In this analysis, they particularly included individuals who were delivered on or after 37 0/7 weeks’ gestation with a live singleton cephalic fetus at the time of labor and delivery admission, had a trial of labor after cesarean delivery, and had a history of 1 previous low-transverse cesarean delivery. They identified 11,687 individuals meeting the inclusion criteria for this secondary analysis, 8,636 of these (74%) experienced vaginal birth after cesarean delivery. Via the backward elimination variable selection, they retrieved a model from the training set including maternal age, prepregnancy weight, height, indication for previous cesarean delivery, obstetrical history, and chronic hypertension. Significantly more likelihood of vaginal birth after cesarean delivery was recorded for women who were taller and had a previous vaginal birth, especially if that vaginal birth had occurred after a previous cesarean delivery. Conversely, significantly less likelihood of vaginal birth after cesarean delivery was recorded for women whose age was older, whose weight was heavier, whose indication for previous cesarean delivery was arrest of dilation or descent, and who had a history of medication-treated chronic hypertension. The successfully derived accurate model is available at https://mfmunetwork.bsc.gwu.edu/web/mfmunetwork/vaginal-birth-after-cesarean-calculator.

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