Prediction of successful labor induction in persons with a low Bishop score using machine learning: Secondary analysis of two randomized controlled trials.

BACKGROUND: The objective of this paper was to identify predictors of a vaginal birth in individuals with singleton pregnancies and a Bishop Score <4, following Induction of Labor (IoL) using dinoprostone vaginal insert (DVI). Secondarily, we sought to understand the association between oxytocin use for labor augmentation and IoL outcomes. METHODS: We developed and internally validated a multivariate prediction model using machine learning (ML) applied to data from two Phase-III randomized controlled double-blind trials (NCT01127581, NCT00308711). The model was internally validated using 10-fold cross-validation. RESULTS: This study included 1107 participants. Despite unfavorable cervical status and inclusion of high-risk pregnancies, 72% of participants had vaginal births. The model's area under receiver operating characteristic curve was 0.73. The following factors increased the chance of vaginal birth: being parous; being between 37 and 41 weeks of gestation; having a lower Body Mass Index; having a lower maternal age; having fewer maternal comorbidities; and having a higher Bishop score. Parity alone correctly predicted the outcome in ~50% of cases, at a ~10% false-negative rate. Participants whose labors progressed without requiring oxytocin had a higher probability of vaginal birth than those requiring oxytocin for either induction or augmentation (81% vs 70% vs 77%, respectively). DISCUSSION: Even in high-risk pregnancies and with low Bishop scores, the use of DVI results in a high chance of vaginal birth. Parity is a critical predictor of success. The judicious use of oxytocin for labor induction or augmentation can increase the chance of vaginal birth. Our study validates the use of ML and predictive modeling for treatment response prediction when considering IoL.

Effects of maternal use of hormonal contraception during breastfeeding: Results from a British birth cohort.

OBJECTIVE: The impact of early hormonal contraception (HC) exposure during breastfeeding on child growth and pubertal and behavioural development was assessed using data from the Avon Longitudinal Study of Parents and Children (Avon study). STUDY DESIGN: The Avon study is a prospective cohort study designed to identify environmental factors affecting child health and development (n = 14,541; delivery dates: 1 April 1991-31 December 1992). This secondary analysis was restricted to breastfed singleton infants. The main independent predictor variable was HC exposure during the first 8 weeks postpartum. Growth variables were changes from baseline in weight and height at ages 2 and 4 years. Behavioural variables were assessed at age 47 months. Pubertal development was evaluated between ages 8- and 16-years using Tanner scales. RESULTS: 9508 children were breastfed during the first 4 weeks postpartum; 8927 had complete data for breastfeeding and HC exposure. Multivariate analyses demonstrated no difference in growth outcome variables between breastfed infants exposed to HC and those who were not. Similarly, no differences in behavioural problems or pubertal development were observed between the two groups. CONCLUSIONS: Early HC exposure during breastfeeding did not appear to influence negatively child growth and development. Limitations include short-term exposure to HC, the discrepancy between the timepoints when HC intake and breastfeeding were measured and the missing data, particularly regarding growth measurements Further clinical studies are required to confirm this lack of negative impact. IMPLICATIONS STATEMENT: Guidance on the use of HC during breastfeeding remains controversial; however, the Avon study did not detect any signal to suggest that early exposure to HC via breastfeeding has a negative impact on child growth, development or behaviour.