Abstract:
Background: Trial of labor after cesarean delivery is defined as an attempt at vaginal delivery in women with a previous caesarean section. Recently there are studies that determine the risk factors for success of VBAC; but in current situation they do not jointly allow prediction of success of VBAC in individual patients in daily practice. Thus, developing risk prediction model and risk score for VBAC, guide health professionals to select pregnant women who are candidate for VBAC.
Objective: To develop prediction model and clinical risk score for the success of vaginal birth after caesarean section among women after a previous caesarean section.
Method: Prognostic study design was conducted from 30th February 2017 to 30th March 2021at Felege Hiwot Comprehensive and Referral Hospital. The sample size (700 subjects) was calculated based on rule of thumb assumptions by assuming 10 events per predictor. Simple random sampling technique was used for selecting study units. Data was coded and entered into Epidata, version 3.02 and was analyzed by using R statistical programming language version 4.0. For model development binary logistic regression was done to investigate the relationship between each predictor and success of vaginal birth after cesarean section. Variables with (p < 0.25) from the bi-variable logistic regression analysis were entered into a backward multivariable logistic regression model, and significant variables (p < 0.05) were retained in the multivariable model. The model performance was evaluated by calculating, ROC curve, Calibration plot, Hosmer-Lemeshow test and p value. To make internal validation boost trapping were done,
Result: The success rate of vaginal birth after cesarean section was 67%. Previous success full vaginal birth after cesarean section ,rupture of membranes, initiation time of ANC, onset of labor, parity and time from previous delivery had a statistically significant association with VBAC success (P < 0.05, AUC of 0.748 (95%CI: 0.714–0.781) sensitivity of 68.23 % and specificity of 71.86%. At the threshold scores of 3.
The model goodness of test had a p-value of 0.255.
Conclusion and Recommendation: In general, this study showed the probability of predicting vaginal birth using , the optimal combination of parity, rupture of membrane ,onset of labor, previous history of VBAC, inter delivery interval and initiation time of ANC. The incidence of success of VBAC was (67%). Thus, using this model could help to identify pregnant women who have a higher probability of having success of VBAC to be candidate for VBAC.
Keywords: Prediction Model, vaginal birth after cesarean section, Ethiopia.