A Predictive Model for Intrapartum Cesarean Delivery in Multiparous Women After Active Labor Onset

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Clinical Prediction Modeling

Background:

• Existing cesarean delivery prediction models primarily focus on nulliparous women.
• There is a need for models predicting intrapartum cesarean delivery in multiparous women, especially after active labor onset.

Purpose of the Study:

• To develop and validate a risk prediction model for intrapartum cesarean delivery in multiparous women.
• To assess the clinical utility of the developed prediction model.

Main Methods:

• Retrospective case-control study involving 58 cases and 116 controls.
• Identified predictors through univariate and multivariate logistic regression analyses.
• Evaluated model performance using discrimination (AUC) and calibration (Hosmer-Lemeshow test), with bootstrap validation.

Main Results:

• A model incorporating prenatal BMI, labor induction, interdelivery interval, fetal abdominal circumference, and amniotic fluid characteristics was developed.
• The model demonstrated good discrimination (AUC = 0.82) and calibration (p=0.91).
• Bootstrap validation confirmed minimal overfitting with a calibration slope of 0.92.

Conclusions:

• A novel prediction model effectively identifies multiparous women at high risk for intrapartum cesarean delivery.
• The model utilizes easily obtainable intrapartum variables, supporting clinical decision-making.
• External validation is recommended prior to widespread clinical implementation.