title: Prediction models for successful external cephalic version: a systematic review.
abstract: To provide an overview of existing prediction models for successful ECV, and to assess their quality, development and performance. We searched MEDLINE, EMBASE and the Cochrane Library to identify all articles reporting on prediction models for successful ECV published from inception to January 2015. We extracted information on study design, sample size, model-building strategies and validation. We evaluated the phases of model development and summarized their performance in terms of discrimination, calibration and clinical usefulness. We collected different predictor variables together with their defined significance, in order to identify important predictor variables for successful ECV. We identified eight articles reporting on seven prediction models. All models were subjected to internal validation. Only one model was also validated in an external cohort. Two prediction models had a low overall risk of bias, of which only one showed promising predictive performance at internal validation. This model also completed the phase of external validation. For none of the models their impact on clinical practice was evaluated. The most important predictor variables for successful ECV described in the selected articles were parity, placental location, breech engagement and the fetal head being palpable. One model was assessed using discrimination and calibration using internal (AUC 0.71) and external validation (AUC 0.64), while two other models were assessed with discrimination and calibration, respectively. We found one prediction model for breech presentation that was validated in an external cohort and had acceptable predictive performance. This model should be used to council women considering ECV.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: j.velzel@amc.nl.
authors.forename: Joost
authors.initials: J
authors.lastname: Velzel
authors.affiliation: Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
authors.forename: Marcella
authors.initials: M
authors.lastname: de Hundt
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Frederique M
authors.initials: FM
authors.lastname: Mulder
authors.affiliation: Department of Obstetrics and Gynaecology, Spaarne Hospital, Hoofddorp, The Netherlands.
authors.forename: Jan F M
authors.initials: JFM
authors.lastname: Molkenboer
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Joris A M
authors.initials: JAM
authors.lastname: Van der Post
authors.affiliation: The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, The South Australian Health and Medical Research Institute, Adelaide, Australia.
authors.forename: Ben W
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Kok
mesh_terms: D019540:Area Under Curve; D001946:Breech Presentation / Q000628:therapy*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D010298:Parity; D010920:Placenta; D011247:Pregnancy; D012372:ROC Curve; D016896:Treatment Outcome; D014710:Version, Fetal / Q000379:methods*
keywords: Breech presentation; External cephalic version; Prediction model