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Nomogram Predicting Intrapartum Cesarean Delivery in Singleton Pregnancies at Term: A Prospective Observational Study
Qiumeng Wang1, Hanglin Wu1, Yun Wang1
1Department of Obstetrics and Gynecology, Hangzhou Women's Hospital, Hangzhou, Zhejiang, People's Republic of China.
Purpose:
The objective of this study was to develop and validate a nomogram designed to predict the likelihood of intrapartum cesarean delivery in singleton pregnancies at term, utilizing an ultrasound-based system.
Patients And Methods:
This prospective study involved women who gave birth at Hangzhou Women's Hospital from August 2022 to March 2024. The study recruited pregnant women who were in a cephalic position, had singleton pregnancies at term (37+0 to 41+6 weeks), and expressed a preference for vaginal delivery. The LaborPro system was employed to perform infrapubic ultrasound imaging and to assess fetal head positioning. A nomogram was generated through multivariate logistic regression analysis, incorporating various maternal, fetal, and pregnancy-related characteristics. The predictive accuracy and discriminative capacity of the nomogram underwent internal validation via 1000-bootstrap resampling. A decision curve analysis was performed to determine a net-benefit threshold for the predictive model.
Results:
A total of 705 women were included, with an observed intrapartum cesarean delivery rate of 13.6%. The logistic regression analysis identified six significant predictors of intrapartum cesarean delivery: maternal height, parity, onset of labor, interspinous diameter, fetal position and estimated fetal weight. Following bootstrap resampling for internal validation, the nomogram demonstrated good calibration, achieving an area under the curve of 0.77 (95% confidence interval, 0.72-0.82). In the induction of labor subgroup, the inclusion of the Bishop score significantly enhanced predictive performance, outperforming existing clinical models (P < 0.001). Decision curve analysis indicated a substantial net benefit across a wide threshold range (0.1-0.7), supporting its utility in shared decision-making.
Conclusion:
The LaborPro-based nomogram provides a validated, objective tool for individualized ICS risk stratification. The integration of internal pelvic dimensions with traditional cervical assessments offers superior predictive accuracy, particularly for women undergoing induction. Future multi-center studies are warranted to externally validate these findings across diverse populations.
