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Q&A

Clinical Obstetrics

Poster Session 1

(209) Validation of Calculator for Cesarean Delivery During Induction of Labor

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective:

We aimed to validate a published risk calculator to predict cesarean delivery (CD) among people undergoing induction of labor (IOL; Rossi, et al. PMID: 32028500) in an external cohort, and to evaluate if a higher predicted CD risk score was associated with a higher likelihood of cesarean or a composite maternal adverse outcome (CMAO).


Study Design:

Our retrospective cohort study included consecutive singleton IOL from 3/2020 to 9/2020. A predicted CD score was calculated using the coefficients of the calculator developed by Rossi et al. External validation of the calculator was assessed by the discriminative power of the model using area under the receiver operating characteristic curve (AUC), and by graphically displaying a calibration curve. The predicted CD score was further categorized as < 20%, 20-40%, and ≥ 40%. The primary outcome was CD, the secondary outcomes was CMAO. Multivariable Poisson regression models with robust error variance estimated the association; adjusted relative risk (aRR) with 95% confidence interval (CI) was calculated.


Results:

Among 548 IOL, 159 (29%) had CD. External validation noted the AUC was 0.77 (95% CI 0.73-0.81) and calibration curve and its 95% confidence band had good calibration (Fig 1A-B). Overall, 277 (50%), 177 (33%), and 94 (17%) had a predicted CD score of < 20%, 20-40%, and ≥ 40%, respectively. After adjustment, compared to individuals with a CD score of < 20%, the likelihood of having a CD was higher in those with a score between 20-40% (aRR 2.40, 95% CI 1.68-3.34) and with a score ≥ 40% (aRR 4.36, 95% CI 3.12-6.10). Compared to those who had a score < 20%, the risk of the CMAO was higher in those with a score ≥ 40% (aRR 1.62, 95% CI 1.10-2.40).



 


Conclusion:

Our external validation suggests that the use of a calculator for predicting CD is feasible. There was a direct correlation between the score and likelihood of CD. A higher CD score was also associated with an increased likelihood of CMAO.