Calculators for Predicting Risk of Cesarean Delivery: A Literature Review.

Importance: Cesarean deliveries are associated with an increased risk of immediate- and long-term complications. Ideally, clinicians could accurately predict the risk of cesarean delivery and use this knowledge to decrease maternal morbidity due to failed labor without increasing rates of unnecessary cesarean delivery. To this end, multiple obstetric calculators for predicting cesarean risk in various clinical settings have been developed.

Objective: This review describes major obstetric calculators for predicting risk of cesarean deliveries and discusses potential clinical applications, general accuracy, and limitations.

Evidence acquisition: An extensive manual review of primary research articles published on PubMed between January 2000 and February 2024 was performed. Pertinent articles that described the creation or validation of a scored system for predicting mode of delivery in an American population were reviewed.

Results: Multiple obstetric calculators have been developed and achieve fair discrimination and calibration in their derivation cohorts but do not maintain accuracy in external populations. This includes calculators that have already been applied to clinical practice, including calculators for predicting vaginal birth after cesarean and success of induction of labor.

Conclusions: Given the limited accuracy of cesarean calculators in external populations, caution is recommended when considering external implementation without further adjustment and refinement. Scores that overestimate cesarean delivery risk could falsely discourage vaginal delivery and negatively impact clinical care.

Relevance: This review provides obstetric clinicians with context for interpreting obstetric calculators for predicting cesarean risk.