Validation of a new calculator for predicting success of vaginal birth after cesarean delivery - 22/08/24

Doi : 10.1016/j.ajog.2024.06.013

Nandini R. Nittur, MD ^a,^⁎ , Carolina Reyes, MD ^b, Maya Marshall, BA ^c, Matthew Ponzini, MS, MPH ^d, Machelle Wilson, PhD ^d, Catherine Cansino, MD, MPH ^b
^a Sansum Clinic, Santa Barbara, CA
^b Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA
^c School of Medicine, University of California, Davis, Sacramento, CA
^d Division of Biostatistics, Clinical and Translational Sciences Center, Department of Public Health Sciences, University of California, Davis, Sacramento, CA

^∗Corresponding author: Nandini R. Nittur, MD.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 22 August 2024

Abstract

Background

Race as a variable in a predictive model for a successful vaginal birth after cesarean delivery has been challenged as contributing to health inequity. In May 2022, the National Institute of Child Health and Development released a modified calculator that removed race as a variable.

Objective

The aim of this study was to externally validate the revised calculator amongst a cohort at our institution.

Study Design

We reviewed all patients who underwent a trial of labor after cesarean delivery in 2018 to 2020 at a tertiary academic medical center and calculated the predicted probability of successful vaginal birth after cesarean delivery for each patient using both original and revised classification calculators and compared these to observed birth outcomes. The area under the receiver operating characteristic curve was calculated for each model.

Results

From the cohort of 225 patients that fit inclusion criteria, 37% (n=83) identified as African American or Hispanic, the vaginal birth after cesarean delivery success rate was 75% for the entire population, and 76% among African American and/or Hispanic patients. The area under the receiver operating characteristic curve of the original calculator was 0.71, compared to 0.74 for the new calculator. For African American and/or Hispanic patients, the average predicted success rates between the models rose from 60% to 69%.

Conclusions

Our review confirmed that African American and Hispanic patients were calculated to have a lower prediction score for a successful vaginal birth after cesarean delivery based on the original calculator as compared to the revised calculator. Our results also suggest that race/ethnicity did not significantly contribute to classification ability of the calculator in our patient population.

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Key words : birth, cesarean, equity, ethnicity, race, TOLAC, VBAC

Plan

Introduction

Methods and materials

Clinical implications

Research implications

Strengths and limitations

	The authors report no conflict of interest.
	The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant number UL1 TR001860.
	Presented at the ACOG Annual Clinical and Scientific Meeting, San Diego CA, May 6–9, 2022.
	Cite this article as: Nittur NR, Reyes C, Marshall M, et al. Validation of a new calculator for predicting success of vaginal birth after cesarean delivery. Am J Obstet Gynecol 2024;XXX:XX–XX.