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 liveborn 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 
Presentation 
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 
Chorioamnionitis 
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% 
Purpose: To estimate the probability of a cesarean delivery in a parous woman in labor using the decision tree analysis of Sims et al.
Specialty: Obstetrics & Gynecology
Objective: risk factors, severity, prognosis, stage
ICD10: O32,