title: Prediction of cesarean section risk in women with gestational hypertension or mild preeclampsia at term.
abstract: OBJECTIVE
  In a recent randomized controlled trial we found that induction of labor in women with gestational hypertension (GH) or mild (preeclampsia) PE at term prevented high risk situations without increasing the cesarean section (CS) rate. We aimed to assess the predictability of the risk of CS.
  
  
  METHODS
  We used multivariable logistic regression analysis to identify predictive factors. Two models were created, one including antepartum and one including antepartum and intrapartum variables. The predictive capacity was assessed with ROC analysis and calibration.
  
  
  RESULTS
  126 (17%) of the 756 women delivered by CS. In multivariable analysis parity (OR 5.4), ethnicity (OR 2.4), previous miscarriage (OR 1.7), creatinine (OR 1.02), proteinuria (OR 2.4), cervical length (OR 1.02), engagement (OR 0.5) and dilatation (OR 0.7) were independent antepartum predictors. Intrapartum variables were parity (OR 3.6), ethnicity (OR 1.9), previous miscarriage (OR 1.5), gestational age at delivery (OR 1.2), antibiotic use (OR 8.0), disease progression (OR 2.4), uric acid (OR 1.4), proteinuria (OR 3.50) and dilatation (OR 0.76). Both models showed good discrimination (AUC 0.74 and 0.80) but calibration was moderate (Hosmer-Lemeshow P-value 0.42 and 0.70).
  
  
  CONCLUSIONS
  In women with GH or mild PE at term, the risk of CS can be predicted.
authors.affiliation: Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: k.van.der.tuuk@og.umcg.nl.
authors.forename: Karin
authors.initials: K
authors.lastname: van der Tuuk
authors.affiliation: Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Maria G
authors.initials: MG
authors.lastname: van Pampus
authors.affiliation: Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Corine M
authors.initials: CM
authors.lastname: Koopmans
authors.affiliation: Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Jan G
authors.initials: JG
authors.lastname: Aarnoudse
authors.affiliation: Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Paul P
authors.initials: PP
authors.lastname: van den Berg
authors.affiliation: Department of Obstetrics and Gynecology, VieCuri Medical Center Noord-Limburg, Venlo, The Netherlands.
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: van Beek
authors.affiliation: Department of Obstetrics and Gynecology, Diaconessenhuis, Leiden, The Netherlands.
authors.forename: Frans J A
authors.initials: FJ
authors.lastname: Copraij
authors.affiliation: Department of Obstetrics and Gynecology, Flevoziekenhuis, Almere, The Netherlands.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Kleiverda
authors.affiliation: Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands.
authors.forename: Martina
authors.initials: M
authors.lastname: Porath
authors.affiliation: Department of Obstetrics and Gynecology, Jeroen Bosch Ziekenhuis, den Bosch, The Netherlands.
authors.forename: Robbert J P
authors.initials: RJ
authors.lastname: Rijnders
authors.affiliation: Department of Obstetrics and Gynecology, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Paulien C M
authors.initials: PC
authors.lastname: van der Salm
authors.affiliation: Department of Obstetrics and Gynecology, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: Leonard P
authors.initials: LP
authors.lastname: Morssink
authors.affiliation: Department of Obstetrics and Gynecology, Deventer Ziekenhuis, Deventer, The Netherlands.
authors.forename: Rob H
authors.initials: RH
authors.lastname: Stigter
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Ben W J
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Henk
authors.initials: H
authors.lastname: Groen
mesh_terms: D000328:Adult; D002585:Cesarean Section; D016002:Discriminant Analysis; D018450:Disease Progression; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D007751:Labor, Induced; D008954:Models, Biological; D009426:Netherlands / Q000453:epidemiology; D010298:Parity; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D057832:Watchful Waiting
keywords: Cesarean section rate; Hypertension; Pre-eclampsia; Prediction models; Pregnancy