Prediction of cesarean delivery in class III obese nulliparous women: An externally validated model using machine learning

Massimo LODI, Audrey POTERIE, Georgios EXARCHAKIS, Camille BRIEN, Pierre LAFAYE DE MICHEAUX, Philippe DERUELLE, Benoît GALLIX

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Abstract

Background: class III obese women, are at a higher risk of cesarean section during labor, and cesarean section is responsible for increased maternal and neonatal morbidity in this population. Objective: the objective of this project was to develop a method with which to quantify cesarean section risk before labor. Methods: this is a multicentric retrospective cohort study conducted on 410 nulliparous class III obese pregnant women who attempted vaginal delivery in two French university hospitals. We developed two predictive algorithms (a logistic regression and a random forest models) and assessed performance levels and compared them. Results: the logistic regression model found that only initial weight and labor induction were significant in the prediction of unplanned cesarean section. The probability forest was able to predict cesarean section probability using only two pre-labor characteristics: initial weight and labor induction. Its performances were higher and were calculated for a cut-point of 49.5% risk and the results were (with 95% confidence intervals): area under the curve 0.70 (0.62,0.78), accuracy 0.66 (0.58, 0.73), specificity 0.87 (0.77, 0.93), and sensitivity 0.44 (0.32, 0.55). Conclusions: this is an innovative and effective approach to predicting unplanned CS risk in this population and could play a role in the choice of a trial of labor versus planned cesarean section. Further studies are needed, especially a prospective clinical trial. Funding: French state funds “Plan Investissements d'Avenir” and Agence Nationale de la Recherche.

Original languageEnglish
Article number102624
JournalJournal of Gynecology Obstetrics and Human Reproduction
Volume52
Issue number7
Early online date13 Jun 2023
DOIs
Publication statusPublished - 1 Sept 2023

Bibliographical note

Funding Information:
This work was supported by French State funds managed within the “ Plan Investissements d'Avenir ” and by the Agence Nationale de la Recherche (ANR) (reference ANR-10-IAHU-02 ).

Keywords

  • Cesarean delivery
  • Machine learning
  • Obesity
  • Personalized medicine
  • Predictive model
  • Predictor selection
  • Random forests

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

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