Development of a modified score system as prediction model for successful vaginal birth after cesarean delivery

Abstract

This study was designed to establish a modified prediction score system to improve the safety and success rate of vaginal birth after cesarean delivery (VBAC). We recruited 406 patients (between January 2012 and December 2016) and generated a modified score system in predicting the success rate of VBAC. All patients were required to sign informed consent forms. 87.2% of patients had successful VBAC and 12.8% patients had repeated cesarean section. We conducted multivariable logistic regression, and found seven variables that were associated with VBAC success, including previous primary indication of cesarean delivery [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.4–3.0], previous vaginal birth history (OR 2.5, 95% CI 1.8–3.8), less than 40 years of age (OR 2.1, 95% CI 1.2–3.3), less than 20 kg weight gain (OR 1.5, 95% CI 1.2–2.3), no labor induction (OR 1.9, 95% CI 1.5–2.9), high score of pelvic/birth weight (OR 1.4, 95% CI 1.1–2.1) and Bishop score (OR 1.3, 95% CI 1.2–1.4). After adjustment for optimism, the area under the receiver operating characteristic curve was 0.849 (95% CI 0.78–0.89), and the modified VBAC score was positively correlated with the success rate of TOLAC (trial of labor after cesarean delivery). A valid and useful score system was established to predict VBAC success rate.

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