title: Vaginal birth after a caesarean section: the development of a Western European population-based prediction model for deliveries at term.
abstract: OBJECTIVE
  To develop and internally validate a model that predicts the outcome of an intended vaginal birth after caesarean (VBAC) for a Western European population that can be used to personalise counselling for deliveries at term.
  
  
  METHODS
  Registration-based retrospective cohort study.
  
  
  METHODS
  Five university teaching hospitals, seven non-university teaching hospitals, and five non-university non-teaching hospitals in the Netherlands.
  
  
  METHODS
  A cohort of 515 women with a history of one caesarean section and a viable singleton pregnancy, without a contraindication for intended VBAC, who delivered at term.
  
  
  METHODS
  Potential predictors for a vaginal delivery after caesarean section were chosen based on literature and expert opinions. We internally validated the prediction model using bootstrapping techniques.
  
  
  METHODS
  Predictors for VBAC. For model validation, the area under the receiver operating characteristic curve (AUC) for discriminative capacity and calibration-per-risk-quantile for accuracy were calculated.
  
  
  RESULTS
  A total of 371 out of 515 women had a VBAC (72%). Variables included in the model were: estimated fetal weight greater than the 90(th) percentile in the third trimester; previous non-progressive labour; previous vaginal delivery; induction of labour; pre-pregnancy body mass index; and ethnicity. The AUC was 71% (95% confidence interval, 95% CI = 69-73%), indicating a good discriminative ability. The calibration plot shows that the predicted probabilities are well calibrated, especially from 65% up, which accounts for 77% of the total study population.
  
  
  CONCLUSIONS
  We developed an appropriate Western European population-based prediction model that is aimed to personalise counselling for term deliveries.
authors.affiliation: Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
authors.forename: E N C
authors.initials: EN
authors.lastname: Schoorel
authors.forename: S M J
authors.initials: SM
authors.lastname: van Kuijk
authors.forename: S
authors.initials: S
authors.lastname: Melman
authors.forename: J G
authors.initials: JG
authors.lastname: Nijhuis
authors.forename: L J M
authors.initials: LJ
authors.lastname: Smits
authors.forename: R
authors.initials: R
authors.lastname: Aardenburg
authors.forename: K
authors.initials: K
authors.lastname: de Boer
authors.forename: F M C
authors.initials: FM
authors.lastname: Delemarre
authors.forename: I M
authors.initials: IM
authors.lastname: van Dooren
authors.forename: M T M
authors.initials: MT
authors.lastname: Franssen
authors.forename: M
authors.initials: M
authors.lastname: Kaplan
authors.forename: G
authors.initials: G
authors.lastname: Kleiverda
authors.forename: S M I
authors.initials: SM
authors.lastname: Kuppens
authors.forename: A
authors.initials: A
authors.lastname: Kwee
authors.forename: F T H
authors.initials: FT
authors.lastname: Lim
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
authors.forename: F J M E
authors.initials: FJ
authors.lastname: Roumen
authors.forename: J M
authors.initials: JM
authors.lastname: Sikkema
authors.forename: E
authors.initials: E
authors.lastname: Smid-Koopman
authors.forename: H
authors.initials: H
authors.lastname: Visser
authors.forename: M
authors.initials: M
authors.lastname: Woiski
authors.forename: R P M G
authors.initials: RP
authors.lastname: Hermens
authors.forename: H C J
authors.initials: HC
authors.lastname: Scheepers
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D020567:Fetal Weight; D006801:Humans; D007751:Labor, Induced; D015233:Models, Statistical; D007744:Obstetric Labor Complications; D063868:Patient Outcome Assessment; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D012372:ROC Curve; D044469:Racial Groups; D012189:Retrospective Studies; D016064:Vaginal Birth after Cesarean
keywords: Personalised decision-making; VBAC; prediction model; vaginal birth after caesarean