Are VBAC prediction models useful in practice?

  • Am J Obstet Gynecol

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Models to predict successful trial of labor after cesarean (TOLAC) may underpredict success. 
  • Consider validation of models for specific populations prior to their use in counseling patients.

Why this matters

  • Counseling patients about the decision for TOLAC vs elective repeat cesarean delivery (CD) often includes individual estimates of success based on vaginal birth after cesarean (VBAC) models.
  • With predicted successful vaginal delivery 

Key results

  • Rate of successful VBAC was 75%.
  • Women with successful VBAC were more likely to:
    • be Hispanic: 37.1%; 
    • have a normal BMI: 38.3%; and/or
    • have a prior vaginal delivery: 54%.
  • Predictive models (Grobman and Metz) were most accurate when predicted probabilities of successful VBAC were >60%.
  • The models underpredicted success when predicted probability

Study design

  • Births following successful and unsuccessful TOLAC between 2013 and 2016 at 1 US institution were identified from an electronic database (n=404).
  • Predictive performance was compared among 3 models and to the actual VBAC rate.
  • Funding: None.

Limitations

  • Data do not include women who elected not to pursue TOLAC.

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