Prognostic model on niche development after a first caesarean section: development and internal validation

Area of Science:

• Reproductive Medicine
• Gynecological Surgery
• Medical Statistics

Background:

• Uterine niche development, an indentation in the scar after cesarean section (CS), is a growing concern.
• Understanding risk factors is crucial for preventing potential complications like abnormal uterine bleeding and infertility.

Purpose of the Study:

• To develop and internally validate a prognostic prediction model for niche development after a first CS.
• To identify patient- and surgery-related risk factors associated with uterine niche formation.

Main Methods:

• Secondary analysis of a randomized controlled trial data from 32 Dutch hospitals.
• Multivariable backward logistic regression and multiple imputation for missing data.
• Internal validation using bootstrapping, assessing calibration and discrimination (AUC).

Main Results:

• Two models were developed (total population and elective CS), identifying risk factors: gestational age, twin pregnancy, smoking, double-layer closure, and less surgical experience.
• Protective factors included multiparity and Vicryl suture material.
• Model performance was poor, with low Nagelkerke R² (0.01-0.05) and failed to poor discriminative ability (AUC 0.56-0.62).

Conclusions:

• The developed prediction model is not suitable for accurately predicting niche development after a first CS.
• Surgical experience and suture material are potential targets for future prevention strategies.
• Further research is needed to identify additional risk factors to improve predictive model accuracy.