The prediction of morbidity related to vaginal delivery in nulliparous women - a secondary analysis from the Genesis multicenter trial

Published on Sep 1, 2021in European Journal of Obstetrics & Gynecology and Reproductive Biology1.868
· DOI :10.1016/J.EJOGRB.2021.07.026
Khadijah I. Ismail2
Estimated H-index: 2
(UL: University of Limerick),
Naomi Burke5
Estimated H-index: 5
(RCSI: Royal College of Surgeons in Ireland)
+ 15 AuthorsAmanda Cotter17
Estimated H-index: 17
(UL: University of Limerick)
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+6-weeks’ gestation from seven tertiary centers. The prediction model used five parameters to assess the risk of CD: maternal age, maternal height, body mass index, fetal head circumference and fetal abdominal circumference. Simple and multiple logistic regression analyses were used to develop the Genesis model. The risk score calculated using this model were correlated with maternal and neonatal morbidity in women who delivered vaginally: postpartum hemorrhage (PPH), obstetric anal sphincter injury (OASI), shoulder dystocia, one- and five-minute Apgar score ≤7, neonatal intensive care (NICU) admission, cephalohematoma, fetal laceration, nerve palsy and fractures. The morbidities associated with spontaneous vaginal delivery were compared with those associated with operative vaginal delivery (OVD). The likelihood ratios for composite morbidity and the morbidity associated with OVD based on the Genesis risk scores were also calculated. null null null Results null A total of 1,845 (79%) nulliparous women had a vaginal delivery. A trend of increasing intervention and morbidity was observed with increasing Genesis risk score, including OVD (p null null null Conclusion null In women who ultimately achieved a vaginal birth, we have shown more maternal and neonatal morbidity in the setting of a Genesis nomogram-determined high-risk score for intrapartum CD. Therefore, the Genesis prediction tool also has the potential to predict a more morbid vaginal delivery.
#1Chadakarn Phaloprakarn (Navamindradhiraj University)H-Index: 5
#2Siriwan Tangjitgamol (Navamindradhiraj University)H-Index: 13
Women with gestational diabetes mellitus (GDM) have a higher risk of cesarean delivery (CD) than glucose-tolerant women. The aim of this study was to develop and validate a risk score for predicting primary CD in women with GDM. A risk score for predicting primary CD was developed using significant clinical features of 385 women who had a diagnosis of GDM and delivered at our institution between January 2011 and December 2014. The score was then tested for validity in another cohort of 448 indiv...
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#1Niamh C. Murphy (RCSI: Royal College of Surgeons in Ireland)H-Index: 5
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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) an...
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The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) is dedicated to the establishment of high standards of practice in obstetrics and gynaecology and women’s health.
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