C Section Prediction in a Parous Woman in Labor - Medical Algorithm

Description

Sims et al used decision tree analysis to predict the probability of a cesarean section being performed in a parous woman in labor. This can help triage the woman for a trial of labor. The authors are from the University of Pittsburgh, Carnegie Mellon University, University of California Los Angeles and Siemens Corporate Research Inc.

Study group: 22,157 women with live-born singleton pregnancies from 1995 to 1997

Parameters:

(1) previous cesarean delivery

(2) rupture of membranes

(3) presentation

(4) fetal growth

(5) fetal distress

(6) preterm

(7) chorioamnionitis

(8) umbilical cord prolapse

(9) placenta previa

Explanation:

(1) The first and second tables were initially one table that was split to simplify placement.

(2) Each terminal cell represents a terminal cell in the decision tree, proceeding from right to left.

Previous Cesarean	Rupture	Presen-tation	Fetal Growth	Fetal Distress	Terminal Cell
Y		mal			1
Y	artificial	normal		Y	2
Y	artificial	normal		N	3
Y	spontan	mal			4
Y	spontan	normal	IUGR		5
Y	spontan	normal	macrosomia		6
Y	spontan	normal	normal		7
N		abnormal lie			8
N		breech			9
N		vertex		Y	10
N		vertex		Y	11
N		vertex		Y	12
N		vertex		Y	13
N		vertex		N	14
N	artificial	vertex		N	15
N	spontan	vertex		N	16
N	spontan	vertex		N	17
N	spontan	vertex		N	18

where:

• One branch point is based on "malpresentation", which is not defined. This is assumed to represent abnormal lie or breech presentation.

Preterm	Chorio-amnionitis	Cord Prolapse	Placenta Previa	Terminal Cell
				1
				2
				3
				4
				5
				6
				7
				8
				9
Y				10
N	Y			11
N	N	Y		12
N	N	N		13
		Y		14
		N		15
Y		N	Y	16
N		N	Y	17
		N	N	18

Terminal Cell	Percent Of Group With Cesarean Delivery
1	77%
2	35%
3	10%
4	95%
5	46%
6	82%
7	54%
8	55%
9	73%
10	52%
11	42%
12	88%
13	10%
14	64%
15	1%
16	69%
17	8%
18	3%

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Description

Specialty

Objective

ICD-10

Terminal Cell	Percent Of Group With Cesarean Delivery
1	77%
2	35%
3	10%
4	95%
5	46%
6	82%
7	54%
8	55%
9	73%
10	52%
11	42%
12	88%
13	10%
14	64%
15	1%
16	69%
17	8%
18	3%

Terminal Cell	Percent Of Group With Cesarean Delivery
1	77%
2	35%
3	10%
4	95%
5	46%
6	82%
7	54%
8	55%
9	73%
10	52%
11	42%
12	88%
13	10%
14	64%
15	1%
16	69%
17	8%
18	3%

Decision Tree Model of Sims et al for Predicting a Cesarean Section in a Parous Woman in Labor

Purpose: To estimate the probability of a cesarean delivery in a parous woman in labor using the decision tree analysis of Sims et al.

Description

Specialty

Objective

ICD-10

Terminal Cell	Percent Of Group With Cesarean Delivery
1	77%
2	35%
3	10%
4	95%
5	46%
6	82%
7	54%
8	55%
9	73%
10	52%
11	42%
12	88%
13	10%
14	64%
15	1%
16	69%
17	8%
18	3%