Abstract
Objective
To develop a prediction model for the chance of successful external cephalic version
(ECV).
Study design
This is a secondary analysis of a multicenter, open-label randomized controlled trial
that assessed the effectiveness of atosiban compared to fenoterol as uterine relaxant
during ECV in women with a singleton fetus in breech presentation with a gestational
age of 36 weeks or more. Potential predictors included maternal, pregnancy, fetal,
and treatment characteristics and were recorded in all participants. Multivariable
logistic regression analysis with a stepwise backward selection procedure was used
to construct a prediction model for the occurrence of successful ECV. Model performance
was assessed using calibration and discrimination.
Results
We included a total of 818 women with an overall ECV success rate of 37%. Ten predictive
factors were identified with the stepwise selection procedure to be associated with
a successful ECV: fenoterol as uterine relaxant, nulliparity, Caucasian ethnicity,
gestational age at ECV, Amniotic Fluid Index, type of breech presentation, placental
location, breech engagement, possibility to palpate the head and relaxation of the
uterus. Our model showed good calibration and a good discriminative ability with a
c-statistic of 0.78 (95% CI 0.75 to 0.81).
Conclusion
Prediction of success of ECV seems feasible with a model showing good performance.
This can be used in clinical practice after external validation.
Keywords
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Article info
Publication history
Published online: June 15, 2018
Accepted:
June 10,
2018
Received in revised form:
April 23,
2018
Received:
February 12,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
