Prediction of intrapartum caesarean section in vaginal breech birth: Development of models for nulliparous and multiparous women

Abstract

Objectives: To develop prediction models for intrapartum caesarean section in vaginal breech birth. Methods: This single-center cohort-study included 262 nulliparous and 230 multiparous women attempting vaginal breech birth. For both groups, we developed and (internally) validated three models for the prediction of intrapartum cesarean section. Results: The prediction model for nulliparous women (AUC: 0.67) included epidural analgesia (aOR 2.14; p=0.01), maternal height (aOR 0.64 per 10cm; p=0.08), birthweight ≥3.8kg (aOR 2.45; p=0.03) and an interaction term describing the effect of OC if birthweight is ≥3.8kg (aOR 0.24; p=0.04). An alternative model for nulliparous women which, instead of birthweight, included fetal abdominal circumference with a cut-off at 34cm (aOR 1.93; p=0.04), showed similar performance (AUC: 0.68). The prediction model for multiparous women (AUC: 0.77) included prelabor rupture of membranes (aOR 0.31; p=0.03), epidural analgesia (aOR 2.42; p=0.07), maternal BMI (aOR 2.92 per 10kg/m2; p=0.01) and maternal age (aOR 3.17 per decade; p=0.06). Conclusions: Our prediction models show the most relevant risk factors associated with intrapartum cesarean section in vaginal breech birth for both nulliparous and multiparous women. Importantly, this study clarifies the role of the OC by showing that this parameter is only associated with intrapartum cesarean section if birthweight is above 3.8kg (or abdominal circumference is above 34cm). Conversely, knowing the OC when the birthweight is less than 3.8kg (or abdominal circumference is less than 34cm) did not improve prediction of this surgical outcome.