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Validating the MFMU TOLAC Calculator in a Canadian Obstetric Population.

Melissa O'Brien1, Lexy Regush1, Thuy Le2

  • 1Department of Obstetrics and Gynecology, University of Saskatchewan, Saskatoon, SK.

Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'Obstetrique Et Gynecologie Du Canada : JOGC
|April 18, 2026
PubMed
Summary

The MFMU tool moderately predicts vaginal birth after Cesarean delivery (VBAC) in Canadian women. Removing chronic hypertension improved prediction, and BMI and height influenced VBAC success.

Keywords:
cesarean deliverytrial of labourvaginal birth after cesarean

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Reproductive Health

Background:

  • Caesarean delivery rates are rising in Canada.
  • Previous Caesarean delivery is a risk factor for repeat Caesarean.
  • Trial of labour after previous Caesarean delivery (TOLAC) is an option for select patients.

Purpose of the Study:

  • To evaluate the predictive accuracy of the Maternal-Fetal Medicine Units (MFMU) Vaginal Birth after Caesarean (VBAC) calculator in a Canadian tertiary care centre.
  • To identify modifications to the MFMU tool to improve its applicability to the local obstetric population.

Main Methods:

  • Analysis of 494 patient charts for TOLAC cases from 2016-2021.
  • Assessment of the MFMU tool's predictive performance for delivery mode.
  • Investigation of factors like chronic hypertension and BMI on VBAC outcomes.

Main Results:

  • The MFMU tool showed fair predictive accuracy for delivery mode (AUC = 0.79).
  • Excluding chronic hypertension enhanced the tool's prediction of VBAC (AUC = 0.81).
  • Body Mass Index (BMI) and patient height significantly influenced VBAC success.

Conclusions:

  • This study is the first to assess the MFMU tool's validity in a Canadian population.
  • The MFMU tool demonstrates moderate predictive value for VBAC in this cohort.
  • Modifications, such as excluding chronic hypertension, can improve the tool's predictive accuracy.