Reducing emergency cesarean delivery and improving the primiparous experience: Findings of the RECIPE study.

Published on Sep 24, 2020in European Journal of Obstetrics & Gynecology and Reproductive Biology1.868
· DOI :10.1016/J.EJOGRB.2020.09.035
Niamh C. Murphy5
Estimated H-index: 5
(RCSI: Royal College of Surgeons in Ireland),
Naomi Burke5
Estimated H-index: 5
(RCSI: Royal College of Surgeons in Ireland)
+ 8 AuthorsFionnuala Breathnach13
Estimated H-index: 13
(RCSI: Royal College of Surgeons in Ireland)
Abstract Objective The ability to predict the need for emergency Cesarean delivery holds the potential to facilitate birth choices. The objective of the RECIPE study (Reducing Emergency Cesarean delivery and Improving the Primiparous Experience) was to externally validate a Cesarean delivery risk prediction model. This model, developed by the Genesis study, identified five key predictive factors for emergency Cesarean delivery: maternal age, maternal height, BMI, fetal head circumference (HC) and fetal abdominal circumference (AC). Study Design This prospective, observational study was conducted in two tertiary referral perinatal centers. Inclusion criteria were as follows: primiparous women with a singleton, cephalic presentation fetus in the absence of fetal growth restriction (FGR), oligohydramnios, pre-eclampsia, pre-existing diabetes mellitus or an indication for planned Cesarean delivery. Between 38 + 0 and 40 + 6 weeks’ gestational age, participants attended for prenatal assessment that enabled the determination of an individualized risk calculation for emergency Cesarean delivery during labour based on maternal height, BMI, fetal HC and AC, with crucially both participants and care providers being blinded to the resultant risk prediction score. Labor, delivery and postnatal outcomes were ascertained. Calibration and receiver operator curves were generated to determine the predictive capacity for emergency Cesarean delivery of the Genesis risk prediction model in this cohort. Results 559 primiparous participants were enrolled from May 2017 to April 2019, of whom 142 (25%) had an emergency Cesarean delivery during labour. Participants with a low predicted risk score ( 50%) had a mean predicted Cesarean delivery rate of 64% (+/- standard deviation of 9%) and also had a high actual observed Cesarean delivery rate (62%). The calibration curve and receiver operating characteristic curve demonstrated that this validation study had comparable discriminatory power for emergency Cesarean delivery to that described in the original Genesis study. The Area Under the Curve (AUC) in Genesis was 0.69, whereas the AUC in RECIPE was 0.72, which reflects good predictive capacity of the risk prediction model. Conclusion The accuracy of the Genesis Cesarean delivery prediction tool is supported by this validation study.
📖 Papers frequently viewed together
12 Citations
5 Authors (Ameer O Abbaker, ..., Ishag Adam)
#1Richard D Riley (Keele University)H-Index: 70
#2Joie Ensor (Keele University)H-Index: 17
Last. Maarten van Smeden (University of Oxford)H-Index: 19
view all 9 authors...
Clinical prediction models aim to predict outcomes in individuals, to inform diagnosis or prognosis in healthcare. Hundreds of prediction models are published in the medical literature each year, yet many are developed using a dataset that is too small for the total number of participants or outcome events. This leads to inaccurate predictions and consequently incorrect healthcare decisions for some individuals. In this article, the authors provide guidance on how to calculate the sample size re...
159 CitationsSource
#1Michael Wilkinson (Imperial College London)H-Index: 1
#2S. Usman (Imperial College Healthcare)H-Index: 6
Last. Christoph Lees (Imperial College London)H-Index: 55
view all 4 authors...
1 CitationsSource
Background Though the same types of complication were found in both elective cesarean section (ElCS) and emergence cesarean section (EmCS), the aim of this study is to compare the rates of maternal and fetal morbidity and mortality between ElCS and EmCS.
31 CitationsSource
#1Vincenzo Berghella (Thomas Jefferson University)H-Index: 85
#2Alexis C. Gimovsky (GW: George Washington University)H-Index: 9
Last. Joy Vink (CUMC: Columbia University Medical Center)H-Index: 18
view all 4 authors...
17 CitationsSource
#1Naomi Burke (RCSI: Royal College of Surgeons in Ireland)H-Index: 5
#2Gerard Burke (UL: University of Limerick)H-Index: 17
Last. Fergal D. Malone (RCSI: Royal College of Surgeons in Ireland)H-Index: 62
view all 16 authors...
Background In contemporary practice many nulliparous women require intervention during childbirth such as operative vaginal delivery or cesarean delivery (CD). Despite the knowledge that the increasing rate of CD is associated with increasing maternal age, obesity and larger infant birthweight, we lack a reliable method to predict the requirement for such potentially hazardous obstetric procedures during labor and delivery. This issue is important, as there are greater rates of morbidity and mor...
38 CitationsSource
#1Masoumeh Rasouli (Shahroud University of Medical Sciences)H-Index: 3
#2Giti Atashsokhan (Shahroud University of Medical Sciences)H-Index: 3
Last. Seyed Abbas Mousavi (Golestan University)H-Index: 11
view all 6 authors...
Objective This study aimed to determine the effectiveness of motivational interviewing on women's participation in childbirth classes and their subsequent natural vaginal delivery. Design Randomised controlled trial. Setting Prenatal clinic of the Shohada Women's Hospital, Behshahr, Mazandaran, Iran. Population This study was conducted with 230 nulliparous women. Participants were randomised into three groups, including 76 women in the motivational interviewing group, and 77 women in both the le...
10 CitationsSource
#1Gary S. Collins (University of Oxford)H-Index: 66
#2Emmanuel O. Ogundimu (University of Oxford)H-Index: 7
Last. Douglas G. Altman (University of Oxford)H-Index: 268
view all 3 authors...
After developing a prognostic model, it is essential to evaluate the performance of the model in samples independent from those used to develop the model, which is often referred to as external validation. However, despite its importance, very little is known about the sample size requirements for conducting an external validation. Using a large real data set and resampling methods, we investigate the impact of sample size on the performance of six published prognostic models. Focussing on unbia...
250 CitationsSource
#1Jong-Wook Ban (University of Oxford)H-Index: 3
#2Jose I. Emparanza (Ciber)H-Index: 16
Last. Amanda Burls (RMIT: RMIT University)H-Index: 45
view all 4 authors...
BACKGROUND: Many new clinical prediction rules are derived and validated. But the design and reporting quality of clinical prediction research has been less than optimal. We aimed to assess whether design characteristics of validation studies were associated with the overestimation of clinical prediction rules' performance. We also aimed to evaluate whether validation studies clearly reported important methodological characteristics. METHODS: Electronic databases were searched for systematic rev...
8 CitationsSource
#2Fiona Cheong-See (QMUL: Queen Mary University of London)H-Index: 6
Last. Ewoud Schuit (Stanford University)H-Index: 24
view all 10 authors...
Health care provision is increasingly focused on the prediction of patients' individual risk for developing a particular health outcome in planning further tests and treatments. There has been a steady increase in the development and publication of prognostic models for various maternal and fetal outcomes in obstetrics. We undertook a systematic review to give an overview of the current status of available prognostic models in obstetrics in the context of their potential advantages and the proce...
89 CitationsSource
#1Torbjørn Moe Eggebø (Stavanger University Hospital)H-Index: 24
#2Charlotte Wilhelm-Benartzi (Imperial College London)H-Index: 16
Last. Christoph Lees (Katholieke Universiteit Leuven)H-Index: 55
view all 6 authors...
Objective Accurate prediction of whether a nulliparous woman will have a vaginal delivery would be a major advance in obstetrics. The objective of the study was to develop such a model based on maternal characteristics and the results of intrapartum ultrasound. Study Design One hundred twenty-two nulliparous women in the first stage of labor were included in a prospective observational 2-centre study. Labor was classified as prolonged according to the respective countries' national guidelines. F...
42 CitationsSource
Cited By1
#1Khadijah I. Ismail (UL: University of Limerick)H-Index: 2
#2Naomi Burke (RCSI: Royal College of Surgeons in Ireland)H-Index: 5
Last. Amanda Cotter (UL: University of Limerick)H-Index: 17
view all 18 authors...
Abstract null null Objective null In the prospective multicenter Genesis study, we developed a prediction model for Cesarean delivery (CD) in term nulliparous women. The objective of this secondary analysis was to determine whether the Genesis model has the potential to predict maternal and neonatal morbidity associated with vaginal delivery. null null null Study Design: null The national prospective Genesis trial recruited 2,336 nulliparous women with a vertex presentation between 39+0- and 40+...