Application of predictive model for vaginal birth after caesarean delivery.
Ruchi Pan, Libin An, Wanwan Zhang and 1 others
PMID 31406794WHAT IT FOUND
Seven models can estimate the chance of vaginal birth after a previous caesarean, but none has been validated for pregnant women in China.
Prior vaginal birth was the most consistently associated factor.
Key findings
01Seven VBAC prediction models were selected and summarised, and prior vaginal birth was the variable most consistently associated with successful VBAC.
02The Troyer and Parisi score uses four variables and ranges from 0 to 4; a score of 0 was associated with a VBAC rate of 91.5%, and scores of 3 or 4 were associated with a VBAC rate of 46.1%.
03The review states that the suitability of these models for predicting VBAC in pregnant women in China has not been clinically verified.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a narrative review, not a test of a model in patients, so it does not show that using any model improves birth outcomes. The models were developed in different countries and populations, and some include ethnicity, which the review says limits applicability. Several models depend on variables that are difficult to collect, such as pre-pregnancy BMI, estimated fetal weight, or the indication for previous caesarean. The review states that the models have not been clinically verified for pregnant women in China. The review does not present a common analysis of the models, so the reported accuracy values and score-based success rates come from different studies.
The easy way to misread this
Do not read the reported success rates or AUC values as proof that these models are ready to use in practice. This is a review, not a patient trial, and the authors say the models have not been clinically verified for pregnant women in China.