Prediction of mode of delivery in term pregnancies: development of scoring system

Swathi Kotha, Pralhad Kushtagi, Krishnapriya Radhakrishnan


Background: The objective of the study was to develop and to validate a scoring system to predict the mode of delivery.

Methods: The study involved 835 term pregnancies in labor. Backward multiple logistic regression analysis was carried out in 600 women to identify the factors independently associated with vaginal or caesarean delivery and logistic coefficients were determined to provide weightage for each of the factors. The total score was calculated for each subject. Sensitivity and specificity for vaginal/ cesarean delivery were calculated for different total scores. The validity of the scoring was studied by applying to the same data provider group retrospectively, and on other 235 laboring women prospectively recruited after the development of score.

Results: Of 600 women, 61.2% had vaginal deliveries. The significant facilitating factors for vaginal delivery were found to be maternal age of 20-25 years (p=0.02), multiparity (p=0.002), unscarred uterus (p=0.05), rhesus positivity (p=0.05), expected baby weight of 2.5-3.5 kg (p=0.004), and with cephalic presentation, Bishop status> 4, spontaneous onset of labor, clear liquor, and no FHR abnormality (p=0.00).A cut off score of 21 predicted the vaginal delivery with sensitivity , specificity, positive predictive value and negative predictive values of 80%, 65%, 70% and 76%, respectively.

Conclusions: The composite score of 21 suggests that woman will most probably have vaginal delivery and that a higher score does not always mean a caesarean delivery.


Clinical prediction, Mode of delivery, Scoring system

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Macones GA, Hausman N, Edelstein R, Stamilo DM, Marder SJ. Predicting outcomes of trials of laborin women attempting vaginal birth after cesarean delivery: a comparison of multivariate methods with neural networks. ACOG. 2001;184:409-13.

Prasad M, Al –Taher H. Maternal height and labour outcome. ObstetGynecol. 2002;22(5):513-5.

Troyer LR, Parisi VM. Obstetric parameters affecting success in a trial of labor: designation of a scoring system. AJOG. 1992;167: 1099-104.

Hashima JN, Guise JM. Vaginal birth after cesarean: a prenatal scoring tool. AJOG. 2007;1965: e22-3.

Flamm BL, Geiger AM. Vaginal birth after cesarean delivery- an admission scoring system. ObstetGynecol. 1997;90:907-10.

Grobman WA, Lai Y, Landon MB, Spong Y, Leveno KJ, Rouse DJ, et al. National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU). Development of a nomogram for prediction of vaginal birth after cesarean delivery. Obstet Gynecol. 2007;109:806-12.

Constantine MM, Fox K, Byres BD, Mathews J, Ghulmiyyah LM, Blackwell S, et al. Validation of the prediction model for the success of vaginal birth after cesarean delivery. Obstet Gynecol. 2009;114:1029-33.

Gonen R, Tamir A, Degani S, Ohel G. Variables associated with successful vaginal birth after one cesarean section: a proposed vaginal birth after cesarean section score. A J Perinatol. 2004;21:447-53.

Dinsmoor MJ, Brock EL. Predicting failed trial of labor after primary cesarean delivery. Obstet Gynecol. 2004;103:282-6.

Hashim N, Naqvi S, Khannam M, Jafry HF. Primigravida as an intrapartum obstetric risk factor. J Pak Med Assoc. 2012;62:694-8.

Dadhwal V, Mittal S, Kumar S, Anand lakshmi PN, Vimal N. Vaginal birth after cesarean delivery-variables affecting outcome. JK Science. 2003;5:11-4

Srinivas SK, Stamilio DM, Stevens EJ, Odibo AO, Peipert JF, Macones GA. Predicting failure of a vaginal birth attempt after cesarean delivery. Obstet Gynecol. 2007;109:800-5.

vanKatwiik C, Peeters LL. Clinical aspects of pregnancy after the age of 35 years: a review of the literature. Hum Reprod Update. 1998;4:185-94.

Dabelea D, Snell-Bergeon JK, Hartsfield CL, Bischoff KJ, Hamman RF, McDuffie RS. Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser Permanente of Colorado GDM Screening Program. Diabetes Care. 2005;28:579-84.

Sheiner E, Levy A, Katz M, Mazor M. Short stature--an independent risk factor for Cesarean delivery. Eur J Obstet Gynecol Reprod Biol. 2005;120:175-8.

National Institute of Health Care and Excellence: Caesarean Section. Predicting CS for cephalopelvic disproportion in labour NICE Guidelines, accessed on August 9, 2015.

Kominiarek MA, Vanveldhuisen P, Hibbard J, Landy H, Haberman S, Learman L, et al. Consortium on Safe Labor. The maternal body mass index: a strong association with delivery route. Am J Obstet Gynecol. 2010;203:264.e1-7.

Tan PC, Suguna S, Vallikkannu N, Hassan J. Ultrasound and clinical predictors for Caesarean delivery after labour induction at term. Aust N Z J. Obstet Gynaecol. 2006;46:505-9.

Vrouenraets FP, Roumen FJ, Dehing CJ, van den Akker ES, Aarts MJ, Scheve EJ. Bishop score and risk of cesarean delivery after induction of labor in nulliparous women. Obstet Gynecol. 2005;105:690-7.

Peregrine E, O'Brien P, Omar R, Jauniaux E. Clinical and ultrasound parameters to predict the risk of cesarean delivery after induction of labor. Obstet Gynecol. 2006;107(2 Pt 1):227–33.

Wang Y, Tanbo T, Abyholm T, Henriksen T. The impact of advanced maternal age and parity on obstetric and perinatal outcomes in singleton gestations. Arch Gynecol Obstet. 2011;284:31-7.

Bodner-Adler B, Bodner K, Pateisky N, Kimberger O, Chalubinski K, Mayerhofer K, Husslein P. Influence of labor induction on obstetric outcomes in patients with prolonged pregnancy: a comparison between elective labor induction and spontaneous onset of labor beyond term. Wien KlinWochenschr. 2005;117:287-92.

Usha Kiran TS, Hemmadi S, Bethel J, Evans J. Outcome of pregnancy in a woman with an increased body mass index. BJOG. 2005;112:768-72.

Gould JB, Davey B, Stafford RS. Socioeconomic differences in rates of cesarean section. N Engl J Med. 1989;321:233-9.

Coppage KH, Polzin WJ. Severe preeclampsia and delivery outcomes: is immediate cesarean delivery beneficial? Am J Obstet Gynecol. 2002;186:921-3.

Kim SN, Park KH, Jung HJ, Hong JS, Shin DM, Kang WS. Clinical and sonographic parameters at 37 weeks' gestation for predicting the risk of primary Cesarean delivery in nulliparous women. Ultrasound Obstet Gynecol. 2010;36:486-92.

Chen G, Uryasev S, Young TK. On prediction of the cesarean delivery risk in a large private practice. Am J Obstet Gynecol. 2004;191:616-24.

van der Merve AM, Thomson JMD, Ekeroma AJ. Factors affecting vaginal birth after caesarean section at Middlemore Hospital, Auckland, New Zealand. NZMJ. 2013;126:1-9.

Ehrenthal DB, Jiang X, Strobino DM. Labor induction and the risk of a cesarean delivery among nulliparouswomen at term. Obstet Gynecol. 2010;116:35-42.

Weinstein D, Benshushan A, Tanos V, Zilberstein R, Rojansky N. Predictive score for vaginal birth after cesarean section. Am J Obstet Gynecol. 1996;174(1 Pt 1):192-8.