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VBAC calculator 2.0: Recent evidence.

Patrick D Thornton1

  • 1College of Nursing, Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA.

Birth (Berkeley, Calif.)
|January 13, 2023
PubMed
Summary
This summary is machine-generated.

The updated VBAC calculator removes race as a predictor, replacing it with chronic hypertension. Further studies are needed to assess its impact on clinical decisions, especially for minority groups.

Keywords:
antiracismintrapartum carepatient educationpatient safetyrace equityracismrisk managementscreening and diagnostic testsvaginal birth after cesarean

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Area of Science:

  • Maternal-Fetal Medicine
  • Reproductive Health Outcomes

Background:

  • The Society for Maternal-Fetal Medicine (SMFM) VBAC calculator has been updated following criticism regarding the use of race as a predictor.
  • The previous version used race (e.g., "African American" or "Hispanic") to predict vaginal birth after cesarean (VBAC) success, leading to systematically lower scores for non-white individuals.
  • The updated calculator replaces race with "chronic hypertension requiring treatment" as a variable.

Approach:

  • This review examines the history and validity of the SMFM VBAC calculator.
  • It analyzes recent studies on the calculator's performance across different racial and ethnic groups, particularly those with lower predicted VBAC success scores.
  • The review also considers the implications of using calculator scores in clinical management decisions regarding labor after cesarean (LAC).

Key Points:

  • The original VBAC calculator demonstrated underprediction of successful VBAC, especially at lower predicted scores.
  • Concerns exist that calculator scores may be used to restrict access to LAC, disproportionately affecting minority populations who face higher cesarean-related morbidity and access barriers.
  • The impact of removing race as a variable on the calculator's performance and accuracy is currently unclear.

Conclusions:

  • While developers report similar accuracy for the updated VBAC calculator, external validation studies are lacking.
  • The use of VBAC calculator scores in clinical decision-making warrants caution, particularly concerning potential restrictions on labor after cesarean (LAC) access for certain patient groups.
  • Further research is essential, including studies with diverse and low-scoring populations, to understand the full effect of the updated calculator and ensure equitable patient care.