title: A clinical prediction model to assess the risk of operative delivery.
abstract: OBJECTIVE
  To predict instrumental vaginal delivery or caesarean section for suspected fetal distress or failure to progress.
  
  
  METHODS
  Secondary analysis of a randomised trial.
  
  
  METHODS
  Three academic and six non-academic teaching hospitals in the Netherlands.
  
  
  METHODS
  5667 labouring women with a singleton term pregnancy in cephalic presentation.
  
  
  METHODS
  We developed multinomial prediction models to assess the risk of operative delivery using both antepartum (model 1) and antepartum plus intrapartum characteristics (model 2). The models were validated by bootstrapping techniques and adjusted for overfitting. Predictive performance was assessed by calibration and discrimination (area under the receiver operating characteristic), and easy-to-use nomograms were developed.
  
  
  METHODS
  Incidence of instrumental vaginal delivery or caesarean section for fetal distress or failure to progress with respect to a spontaneous vaginal delivery (reference).
  
  
  RESULTS
  375 (6.6%) and 212 (3.6%) women had an instrumental vaginal delivery or caesarean section due to fetal distress, and 433 (7.6%) and 571 (10.1%) due to failure to progress, respectively. Predictors were age, parity, previous caesarean section, diabetes, gestational age, gender, estimated birthweight (model 1) and induction of labour, oxytocin augmentation, intrapartum fever, prolonged rupture of membranes, meconium stained amniotic fluid, epidural anaesthesia, and use of ST-analysis (model 2). Both models showed excellent calibration and the receiver operating characteristics areas were 0.70-0.78 and 0.73-0.81, respectively.
  
  
  CONCLUSIONS
  In Dutch women with a singleton term pregnancy in cephalic presentation, antepartum and intrapartum characteristics can assist in the prediction of the need for an instrumental vaginal delivery or caesarean section for fetal distress or failure to progress.
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands. e.schuit@umcutrecht.nl
authors.forename: E
authors.initials: E
authors.lastname: Schuit
authors.forename: A
authors.initials: A
authors.lastname: Kwee
authors.forename: M E M H
authors.initials: ME
authors.lastname: Westerhuis
authors.forename: H J H M
authors.initials: HJ
authors.lastname: Van Dessel
authors.forename: G C M
authors.initials: GC
authors.lastname: Graziosi
authors.forename: J M M
authors.initials: JM
authors.lastname: Van Lith
authors.forename: J G
authors.initials: JG
authors.lastname: Nijhuis
authors.forename: S G
authors.initials: SG
authors.lastname: Oei
authors.forename: H P
authors.initials: HP
authors.lastname: Oosterbaan
authors.forename: N W E
authors.initials: NW
authors.lastname: Schuitemaker
authors.forename: M G A J
authors.initials: MG
authors.lastname: Wouters
authors.forename: G H A
authors.initials: GH
authors.lastname: Visser
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
authors.forename: K G M
authors.initials: KG
authors.lastname: Moons
authors.forename: R H H
authors.initials: RH
authors.lastname: Groenwold
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis*; D006801:Humans; D008954:Models, Biological; D049451:Nomograms; D007744:Obstetric Labor Complications / Q000175:diagnosis*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D014710:Version, Fetal