Abstract
This study aimed to develop and validate a prediction model of cesarean following induction of labor (IOL). A nomogram for the prediction of cesarean following IOL for singleton, cephalic term deliveries was created by comparing combinations of ultrasonographic and nonultrasonographic factors in a retrospective manner using patient data collected from a Chinese hospital between July, 2017 and December, 2023. Model discrimination and calibration were evaluated using the area under the receiver operating characteristic curve (AUROC) and a calibration curve. Subsequently, decision curve analysis (DCA) was conducted to pinpoint the optimal probability threshold for the predictive model to exhibit practical significance for clinical decision-making. A total of 738 women were included. The inclusion of ultrasound factors yielded a higher AUC when combined with nonultrasonographic factors. Of the three ultrasonographic factors analyzed, the most predictive factor for cesarean following IOL was fetal head circumference. After generating a nomogram with eight validated factors, including maternal age, gestational age, height, prior caesarean delivery, previous vaginal delivery, modified Bishop score, body mass index at delivery, and fetal head circumference by ultrasound, the trained and validated AUC values were 0.826 (95% confidence interval 0.786-0.867) and 0.883 (95% confidence interval 0.839-0.926), respectively. Decision curve analysis indicated that the model provided net benefits of between 0% and 80% of the probability threshold, indicating the benefits of using the model to make decisions concerning patients who fall within the identified range of the probability threshold. Our nomogram based on obstetric factors and fetal head circumference as obtained by ultrasound could be used to help counsel women who are considering IOL. The model demonstrates favorable net benefits within a probability threshold range of 0 to 80%.