Maternal and fetal characteristics to predict c-section delivery: A scoring system for pregnant women

Introduction: Cesarean section is one of the most common obstetrical interventions that has been performed at an increasing rate globally, due to both medical and non-medical reasons. This study aims to develop a prediction tool for pregnant women potentially needing c-section, such that necessary p...

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Autores principales:	Rima Irwinda, Rabbania Hiksas, Angga Wiratama Lokeswara, Noroyono Wibowo
Formato:	article
Lenguaje:	EN
Publicado:	SAGE Publishing 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/675ddcad64534533a1eb360efeaf5afe
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spelling	oai:doaj.org-article:675ddcad64534533a1eb360efeaf5afe2021-12-01T22:35:51ZMaternal and fetal characteristics to predict c-section delivery: A scoring system for pregnant women1745-506510.1177/17455065211061969https://doaj.org/article/675ddcad64534533a1eb360efeaf5afe2021-11-01T00:00:00Zhttps://doi.org/10.1177/17455065211061969https://doaj.org/toc/1745-5065Introduction: Cesarean section is one of the most common obstetrical interventions that has been performed at an increasing rate globally, due to both medical and non-medical reasons. This study aims to develop a prediction tool for pregnant women potentially needing c-section, such that necessary preparations from the mothers, families, and health providers can be made. Methods: A total of 603 pregnant women were recruited in the first phase of c-section prediction tool development. The association between the maternal and fetal factors on the risk of c-section were analyzed, followed by a stepwise multivariate regression analysis. In the next phase, 61 pregnant women were enrolled for external validation. Discrimination was assessed using area under the curve. The calibration plot was then made and assessed using the Hosmer–Lemeshow test. Results: There were 251 (41.6%) cases of vaginal delivery and 352 (58.4%) of c-section assessed. Multivariate analysis showed that gestational age < 37 wg (OR: 1.66, 95% CI: 1.10–2.51), pre-pregnancy body mass index (underweight) (OR: 0.40, 95% CI: 0.22–0.76), no history of vaginal delivery (OR: 2.66, 95% CI: 1.76–4.02), history of uterine surgery (OR: 8.34, 95% CI: 4.54–15.30), obstetrical complications (OR: 5.61, 95% CI: 3.53–8.90), birthweight ⩾ 3500 g (OR: 4.28, 95% CI: 2.16–8.47), and non-cephalic presentation (OR: 2.74, 95% CI: 1.53–4.89) were independently associated with c-section delivery. Those parameters were included in a 7-item scoring tool, with consecutive predictive scores of 1,–1,2,3,3,2,2,1. The area under the curve result was 0.813 (95% CI: 0.779–0.847), indicating a good predictive ability. The external validation showed AUC: 0.806, 95% CI: 0.694–0.917, Hosmer–Lemeshow test p = 0.666 and calibration plot coefficient of r = 0.939. Conclusion: A total of 7 maternal-fetal factors were found to be strongly associated with c-section delivery, including gestational age < 37, maternal underweight body mass index, previous uterine surgery, obstetrical complications, birthweight ⩾ 3500, history of vaginal delivery, and non-cephalic presentation. Using these factors, a prediction tool was developed and validated with good quality.Rima IrwindaRabbania HiksasAngga Wiratama LokeswaraNoroyono WibowoSAGE PublishingarticleMedicineRENWomen's Health, Vol 17 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Rima Irwinda Rabbania Hiksas Angga Wiratama Lokeswara Noroyono Wibowo Maternal and fetal characteristics to predict c-section delivery: A scoring system for pregnant women
description	Introduction: Cesarean section is one of the most common obstetrical interventions that has been performed at an increasing rate globally, due to both medical and non-medical reasons. This study aims to develop a prediction tool for pregnant women potentially needing c-section, such that necessary preparations from the mothers, families, and health providers can be made. Methods: A total of 603 pregnant women were recruited in the first phase of c-section prediction tool development. The association between the maternal and fetal factors on the risk of c-section were analyzed, followed by a stepwise multivariate regression analysis. In the next phase, 61 pregnant women were enrolled for external validation. Discrimination was assessed using area under the curve. The calibration plot was then made and assessed using the Hosmer–Lemeshow test. Results: There were 251 (41.6%) cases of vaginal delivery and 352 (58.4%) of c-section assessed. Multivariate analysis showed that gestational age < 37 wg (OR: 1.66, 95% CI: 1.10–2.51), pre-pregnancy body mass index (underweight) (OR: 0.40, 95% CI: 0.22–0.76), no history of vaginal delivery (OR: 2.66, 95% CI: 1.76–4.02), history of uterine surgery (OR: 8.34, 95% CI: 4.54–15.30), obstetrical complications (OR: 5.61, 95% CI: 3.53–8.90), birthweight ⩾ 3500 g (OR: 4.28, 95% CI: 2.16–8.47), and non-cephalic presentation (OR: 2.74, 95% CI: 1.53–4.89) were independently associated with c-section delivery. Those parameters were included in a 7-item scoring tool, with consecutive predictive scores of 1,–1,2,3,3,2,2,1. The area under the curve result was 0.813 (95% CI: 0.779–0.847), indicating a good predictive ability. The external validation showed AUC: 0.806, 95% CI: 0.694–0.917, Hosmer–Lemeshow test p = 0.666 and calibration plot coefficient of r = 0.939. Conclusion: A total of 7 maternal-fetal factors were found to be strongly associated with c-section delivery, including gestational age < 37, maternal underweight body mass index, previous uterine surgery, obstetrical complications, birthweight ⩾ 3500, history of vaginal delivery, and non-cephalic presentation. Using these factors, a prediction tool was developed and validated with good quality.
format	article
author	Rima Irwinda Rabbania Hiksas Angga Wiratama Lokeswara Noroyono Wibowo
author_facet	Rima Irwinda Rabbania Hiksas Angga Wiratama Lokeswara Noroyono Wibowo
author_sort	Rima Irwinda
title	Maternal and fetal characteristics to predict c-section delivery: A scoring system for pregnant women
title_short	Maternal and fetal characteristics to predict c-section delivery: A scoring system for pregnant women
title_full	Maternal and fetal characteristics to predict c-section delivery: A scoring system for pregnant women
title_fullStr	Maternal and fetal characteristics to predict c-section delivery: A scoring system for pregnant women
title_full_unstemmed	Maternal and fetal characteristics to predict c-section delivery: A scoring system for pregnant women
title_sort	maternal and fetal characteristics to predict c-section delivery: a scoring system for pregnant women
publisher	SAGE Publishing
publishDate	2021
url	https://doaj.org/article/675ddcad64534533a1eb360efeaf5afe
work_keys_str_mv	AT rimairwinda maternalandfetalcharacteristicstopredictcsectiondeliveryascoringsystemforpregnantwomen AT rabbaniahiksas maternalandfetalcharacteristicstopredictcsectiondeliveryascoringsystemforpregnantwomen AT anggawiratamalokeswara maternalandfetalcharacteristicstopredictcsectiondeliveryascoringsystemforpregnantwomen AT noroyonowibowo maternalandfetalcharacteristicstopredictcsectiondeliveryascoringsystemforpregnantwomen
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Maternal and fetal characteristics to predict c-section delivery: A scoring system for pregnant women

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