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Published on: June 6, 2020
Validated Calculators Predicting Cesarean Delivery After Induction: Accuracy in an External Population.
Shirley J Shao1, E Nicole Teal, Adam K Lewkowitz
1School of Medicine and the Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and the Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Providence, Rhode Island.
Two calculators for predicting cesarean delivery after labor induction showed poor performance in an external population. They overestimated cesarean risk, suggesting caution against their widespread use without refinement.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Clinical Prediction Models
Background:
- Accurate prediction of cesarean delivery risk is crucial for managing labor induction.
- Existing predictive calculators aim to inform clinical decision-making but require external validation.
Purpose of the Study:
- To assess the performance of two published cesarean delivery risk calculators in an independent cohort.
- To evaluate the accuracy of these calculators in predicting cesarean delivery following induction of labor.
Main Methods:
- A cohort study included 846 nulliparous patients with singleton, term, vertex fetuses, intact membranes, and unfavorable cervices undergoing labor induction.
- Predicted cesarean risk scores were calculated using two established calculators.
- Observed and predicted cesarean delivery rates were compared overall and within risk strata.
Main Results:
- Both calculators significantly overestimated the overall cesarean delivery rate (predicted 40.0% and 36.2% vs. observed 31.0%).
- Overestimation was particularly pronounced in higher-risk tertiles.
- Areas under the receiver operating characteristic curves were ≤0.57, indicating poor predictive ability.
Conclusions:
- Previously published cesarean delivery prediction calculators demonstrated poor performance in this external population.
- Falsely high predicted risks may negatively impact patient and provider decisions regarding induction of labor.
- These calculators require significant population-specific refinement before widespread clinical implementation.
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