Prediction of cesarean section risk in women with gestational hypertension or mild preeclampsia at term

Eur J Obstet Gynecol Reprod Biol. 2015 Aug:191:23-7. doi: 10.1016/j.ejogrb.2015.05.009. Epub 2015 May 30.

Abstract

Objective: In a recent randomized controlled trial we found that induction of labor in women with gestational hypertension (GH) or mild (preeclampsia) PE at term prevented high risk situations without increasing the cesarean section (CS) rate. We aimed to assess the predictability of the risk of CS.

Study design: We used multivariable logistic regression analysis to identify predictive factors. Two models were created, one including antepartum and one including antepartum and intrapartum variables. The predictive capacity was assessed with ROC analysis and calibration.

Results: 126 (17%) of the 756 women delivered by CS. In multivariable analysis parity (OR 5.4), ethnicity (OR 2.4), previous miscarriage (OR 1.7), creatinine (OR 1.02), proteinuria (OR 2.4), cervical length (OR 1.02), engagement (OR 0.5) and dilatation (OR 0.7) were independent antepartum predictors. Intrapartum variables were parity (OR 3.6), ethnicity (OR 1.9), previous miscarriage (OR 1.5), gestational age at delivery (OR 1.2), antibiotic use (OR 8.0), disease progression (OR 2.4), uric acid (OR 1.4), proteinuria (OR 3.50) and dilatation (OR 0.76). Both models showed good discrimination (AUC 0.74 and 0.80) but calibration was moderate (Hosmer-Lemeshow P-value 0.42 and 0.70).

Conclusion: In women with GH or mild PE at term, the risk of CS can be predicted.

Keywords: Cesarean section rate; Hypertension; Pre-eclampsia; Prediction models; Pregnancy.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cesarean Section*
  • Discriminant Analysis
  • Disease Progression
  • Female
  • Humans
  • Hypertension, Pregnancy-Induced / diagnosis*
  • Hypertension, Pregnancy-Induced / physiopathology
  • Hypertension, Pregnancy-Induced / therapy
  • Labor, Induced*
  • Models, Biological*
  • Netherlands / epidemiology
  • Parity
  • Pre-Eclampsia / diagnosis*
  • Pre-Eclampsia / physiopathology
  • Pre-Eclampsia / therapy
  • Pregnancy
  • Pregnancy Trimester, Third
  • Prognosis
  • ROC Curve
  • Risk Factors
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Watchful Waiting*