A predictive model for caesarean section during labour in women with pre-eclampsia
The study developed a predictive model for caesarean section in women with pre-eclampsia, achieving an AUC of 0.601, which indicates moderate predictive efficacy.
Where it sits
this study against the rest of the oxytocin corpusSummary and findings
This study investigated risk factors for caesarean section (CS) during delivery in women with pre-eclampsia. A total of 627 women were included, and a predictive scoring model was developed. The model demonstrated an area under the curve (AUC) of 0.601 for predicting the need for CS.
Abstract
<title>Abstract</title> <p> <bold>Objective:</bold> To investigate the risk factors for caesarean section (CS) during delivery in patients with pre-eclampsia. <bold>Methods:</bold> A retrospective cohort study was conducted at Gansu Provincial People’s Hospital, a Grade A tertiary maternity centre, all women with pre-eclampsia who underwent trial of labour between 2005 and 2025 were identified. In accordance with inclusion and exclusion criteria, key data—including demographic characteristics and clinical monitoring indicators—were collected. Univariate and multivariate analyses were performed to identify factors associated with CD, and a scoring model was developed using receiver operating characteristic (ROC) curves to predict the need for CD. <bold>Results:</bold> A total of 1,128 women with pre-eclampsia were identified, of whom 627 were included in the study. Among these, gestational age at delivery, weight gain during pregnancy, neonatal birth weight, preterm birth, oxytocin-induced labour, use of analgesic techniques, intrapartum fever, birth weight ≥2,500 g, number of previous deliveries ≥ 2, and 24-hour urine protein > 0.3 g/24 h were all identified as risk factors for intrapartum caesarean section. Subsequently, we developed a predictive scoring model for intrapartum caesarean section in women with pre-eclampsia; this model had an AUC of 0.601, demonstrating predictive efficacy (95% confidence interval 0.556–0.646, p < 0.001). <bold>Conclusion:</bold> The occurrence of caesarean section during delivery in patients with pre-eclampsia is associated with maternal and intrapartum factors. A predictive model based on these factors can assist in identifying high-risk patients and provide a basis for formulating delivery plans. </p>
Background
This paper addresses the clinical question of identifying risk factors for caesarean section during labor in women with pre-eclampsia. Prior research has indicated various maternal and intrapartum factors that may influence the likelihood of CS. Understanding these factors can help in planning deliveries for high-risk patients.
Methods
A retrospective cohort study was conducted at Gansu Provincial People’s Hospital, involving women with pre-eclampsia who underwent trial of labor between 2005 and 2025. Key demographic and clinical data were collected, and univariate and multivariate analyses were performed to identify associated factors. A predictive scoring model was developed using ROC curves.
Results
The primary endpoint was the predictive model's AUC of 0.601, indicating moderate predictive efficacy with a 95% confidence interval of 0.556–0.646 and a p-value of less than 0.001. Various risk factors for intrapartum caesarean section were identified, including gestational age and oxytocin-induced labor.
Interpretation
The findings suggest that while the predictive model shows statistical significance, the AUC of 0.601 indicates only moderate predictive ability, which may limit its clinical utility. The study's retrospective design and potential confounding factors may also influence the reliability of the results. This research contributes to the existing literature on pre-eclampsia and CS but should be interpreted with caution.
Key findings
- AUC of predictive model = 0.601, 95% CI 0.556–0.646, p < 0.001.
- Total n = 1,128 women identified, 627 included in the study.
- Risk factors included gestational age, weight gain, neonatal birth weight, preterm birth, oxytocin-induced labour, analgesic techniques, intrapartum fever, birth weight ≥2,500 g, number of previous deliveries ≥ 2, and 24-hour urine protein > 0.3 g/24 h.
Limitations
- Retrospective cohort study design.
- Moderate predictive ability indicated by AUC of 0.601.
- Potential confounding factors not fully controlled.
- Single-site study may limit generalizability.