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Operative Obstetrics

Poster Session 1

(179) A Novel and Modern VBAC Calculator for use Prior to Labor

Tuesday, February 13, 2024

10:30 AM – 12:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Alexis C. Gimovsky, MD

Associate Professor
Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
Providence, RI, United States

Coauthor(s)

SM

Silas Monje, BA

Alpert Medical School of Brown University
Providence, RI, United States
JD

Jack Dunn, PhD

Interpretable AI
Cambridge, MA, United States
JL

Jordan Levine, BA, MA

Dynamic Sky
Providence, RI, United States

Objective: To develop a prediction model for individualized risks and benefits of a trial of labor after cesarean using modern mathematical techniques.

Study Design: This was a secondary analysis of the Cesarean Registry database. Primary outcome: prediction of success of vaginal birth after cesarean (VBAC). Secondary outcomes: prediction of uterine rupture, maternal complications, neonatal complications. Inclusion criteria: term, singletons, cephalic presentation, one prior low transverse cesarean delivery. Exclusion criteria: intrauterine fetal demise, planned cesarean, prior myomectomy. Univariate comparisons identified variables that were independently associated with VBAC. An optimal decision tree was used to create a prediction model. A test set was withheld for validation. A risk calculator tool was developed for prediction of successful VBAC and adverse perinatal outcomes. Adverse maternal outcomes: uterine dehiscence, hysterectomy, postpartum hemorrhage, endometritis, intensive care unit admission, thromboembolic event, readmission, organ injury. Adverse neonatal outcomes: hypoxic ischemic encephalopathy, respiratory distress, seizures, apnea, respirator use, death, cord blood ph < 7.1.

Results: The study population included 73262 deliveries; 12942 patients met inclusion and exclusion criteria. After removing cases for the test set, the included patients were 8078 patients, of which 5970 people had a successful VBAC (73.9%). Parity, number of years since prior cesarean delivery, pre-pregnancy body mass index (BMI), delivery BMI, maternal age, previous VBAC were associated with successful VBAC. A risk predictor calculator was created, and a ROC curve was developed with AN AUC was 0.72. The tool was also developed to identify a person’s risk of uterine rupture, composite maternal morbidity and neonatal morbidity.

Conclusion: VBAC for patients with term, cephalic, singleton gestations were associated with several variables. This advanced calculator tool will facilitate shared decision making about the value of a TOLAC regarding the personalized risks of maternal and neonatal morbidity.