Skip to main content
Erschienen in: International Urogynecology Journal 9/2021

12.03.2021 | Original Article

Prediction model for obstetric anal sphincter injury using machine learning

verfasst von: Henry Hillel Chill, Joshua Guedalia, Michal Lipschuetz, Tzvika Shimonovitz, Ron Unger, David Shveiky, Gilad Karavani

Erschienen in: International Urogynecology Journal | Ausgabe 9/2021

Einloggen, um Zugang zu erhalten

Abstract

Introduction and hypothesis

Obstetric anal sphincter injury (OASI) is a complication with substantial maternal morbidity. The aim of this study was to develop a machine learning model that would allow a personalized prediction algorithm for OASI, based on maternal and fetal variables collected at admission to labor.

Materials and methods

We performed a retrospective cohort study at a tertiary university hospital. Included were term deliveries (live, singleton, vertex). A comparison was made between women diagnosed with OASI and those without such injury. For formation of a machine learning-based model, a gradient boosting machine learning algorithm was implemented. Evaluation of the performance model was achieved using the area under the receiver-operating characteristic curve (AUC).

Results

Our cohort comprised 98,463 deliveries, of which 323 (0.3%) were diagnosed with OASI. Applying a machine learning model to data recorded during admission to labor allowed for individualized risk assessment with an AUC of 0.756 (95% CI 0.732–0.780). According to this model, a lower number of previous births, fewer pregnancies, decreased maternal weight and advanced gestational week elevated the risk for OASI. With regard to parity, women with one previous delivery had approximately 1/3 of the risk for OASI compared to nulliparous women (OR = 0.3 (0.23–0.39), p < 0.001), and women with two previous deliveries had 1/3 of the risk compared to women with one previous delivery (OR = 0.35 (0.21–0.60), p < 0.001).

Conclusion

Our machine learning-based model stratified births to high or low risk for OASI, making it an applicable tool for personalized decision-making upon admission to labor.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Stock L, Basham E, Gossett DR, Lewicky-Gaupp C. Factors associated with wound complications in women with obstetric anal sphincter injuries (OASIS). Am J Obstet Gynecol. 2013;208:327.e1–6.CrossRef Stock L, Basham E, Gossett DR, Lewicky-Gaupp C. Factors associated with wound complications in women with obstetric anal sphincter injuries (OASIS). Am J Obstet Gynecol. 2013;208:327.e1–6.CrossRef
2.
Zurück zum Zitat Fernando RJ, Sultan AH, Kettle C, Thakar R. Methods of repair for obstetric anal sphincter injury. Cochrane Database Syst Rev. 2013;12:CD002866. Fernando RJ, Sultan AH, Kettle C, Thakar R. Methods of repair for obstetric anal sphincter injury. Cochrane Database Syst Rev. 2013;12:CD002866.
3.
Zurück zum Zitat Handa VL, Blomquist JL, McDermott KC, Friedman S, Munoz A. Pelvic floor disorders after childbirth: effect of episiotomy, perineal laceration and operative birth. Obstet Gynecol. 2012;119:233–9.CrossRef Handa VL, Blomquist JL, McDermott KC, Friedman S, Munoz A. Pelvic floor disorders after childbirth: effect of episiotomy, perineal laceration and operative birth. Obstet Gynecol. 2012;119:233–9.CrossRef
4.
Zurück zum Zitat Fitzpatrick M, O’Herlihy C. Short-term and long-term effects of obstetric anal sphincter injury and their management. Curr Opin Obstet Gynecol. 2005;17:605–10.CrossRef Fitzpatrick M, O’Herlihy C. Short-term and long-term effects of obstetric anal sphincter injury and their management. Curr Opin Obstet Gynecol. 2005;17:605–10.CrossRef
5.
Zurück zum Zitat Richter HE, Nager CW, Burgio KL, Whitworth R, Weidner AC, Schaffer J, et al. Incidence and predictors of anal incontinence after obstetric anal sphincter injury in primiparous women. Female Pelvic Med Reconstr Surg. 2015;21:182–9.CrossRef Richter HE, Nager CW, Burgio KL, Whitworth R, Weidner AC, Schaffer J, et al. Incidence and predictors of anal incontinence after obstetric anal sphincter injury in primiparous women. Female Pelvic Med Reconstr Surg. 2015;21:182–9.CrossRef
6.
Zurück zum Zitat Nordenstam J, Altman D, Brismaz S, Zetterstrצּm J. Natural progression of anal incontinence after childbirth. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(9):1029–35.CrossRef Nordenstam J, Altman D, Brismaz S, Zetterstrצּm J. Natural progression of anal incontinence after childbirth. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(9):1029–35.CrossRef
7.
Zurück zum Zitat Wegnelius G. Hammarstrצm M. complete rupture of anal sphincter in primiparas: long term effects and subsequent delivery. Acta Obstet Gynecol Scand. 2011;90(3):258–63.PubMed Wegnelius G. Hammarstrצm M. complete rupture of anal sphincter in primiparas: long term effects and subsequent delivery. Acta Obstet Gynecol Scand. 2011;90(3):258–63.PubMed
8.
Zurück zum Zitat Ott J, Gritsch E, Pils S, et al. A retrospective study on perineal lacerations in vaginal delivery and the individual performance of experienced midwives. BMC Pregnancy Childbirth. 2015;15:270.CrossRef Ott J, Gritsch E, Pils S, et al. A retrospective study on perineal lacerations in vaginal delivery and the individual performance of experienced midwives. BMC Pregnancy Childbirth. 2015;15:270.CrossRef
9.
Zurück zum Zitat Low LK, Zielinski R, Tao Y, Galecki A, Brandon CJ, Miller JM. Predicting birth-related levator ani tear severity in primiparous women: evaluating maternal recovery from labor and delivery (EMRLD study). Open J Obstet Gynecol. 2014;4:266–78.CrossRef Low LK, Zielinski R, Tao Y, Galecki A, Brandon CJ, Miller JM. Predicting birth-related levator ani tear severity in primiparous women: evaluating maternal recovery from labor and delivery (EMRLD study). Open J Obstet Gynecol. 2014;4:266–78.CrossRef
10.
Zurück zum Zitat Andrews V, Sultan AH, Thakar R, Jones PW. Risk factors for obstetric anal sphincter injury: a prospective study. Birth. 2006;33:117–22.CrossRef Andrews V, Sultan AH, Thakar R, Jones PW. Risk factors for obstetric anal sphincter injury: a prospective study. Birth. 2006;33:117–22.CrossRef
11.
Zurück zum Zitat Baghestan E, Irgens LM, Bordahl PE, Rasmussen S. Trends in risk factors for obstetric anal sphincter injuries in Norway. Obstet Gynecol. 2010;116:25–34.CrossRef Baghestan E, Irgens LM, Bordahl PE, Rasmussen S. Trends in risk factors for obstetric anal sphincter injuries in Norway. Obstet Gynecol. 2010;116:25–34.CrossRef
12.
Zurück zum Zitat Deo RC. Machine learning in medicine. Circulation. 2015;132(20):1920–30.CrossRef Deo RC. Machine learning in medicine. Circulation. 2015;132(20):1920–30.CrossRef
13.
Zurück zum Zitat Obermeyer Z, Emanuel EJ. Predicting the future - big data, machine learning and 509 clinical medicine. N Engl J Med. 2016;375(13):1216–9.CrossRef Obermeyer Z, Emanuel EJ. Predicting the future - big data, machine learning and 509 clinical medicine. N Engl J Med. 2016;375(13):1216–9.CrossRef
14.
Zurück zum Zitat Guedalia J, Lipschuetz M, Novoselsky Persky M, et al. Real-time data analysis using a machine learning model significantly improves prediction of successful vaginal deliveries. Am J Obstet Gynecol. 2020;223(3):437.CrossRef Guedalia J, Lipschuetz M, Novoselsky Persky M, et al. Real-time data analysis using a machine learning model significantly improves prediction of successful vaginal deliveries. Am J Obstet Gynecol. 2020;223(3):437.CrossRef
15.
Zurück zum Zitat McPherson KC, Beggs AD, Sultan AH, Thaker R. Can the risk of obstetric anal sphincter injuries (OASIs) be predicted using a risk-scoring system? BMC Research Notes. 2014;7:471.CrossRef McPherson KC, Beggs AD, Sultan AH, Thaker R. Can the risk of obstetric anal sphincter injuries (OASIs) be predicted using a risk-scoring system? BMC Research Notes. 2014;7:471.CrossRef
16.
Zurück zum Zitat Meister MR, Cahill AG, Conner SN, Woolfolk CL, Lowder JL. Predicting obstetric anal sphincter injuries in a modern obstetric population. Am J Obstet Gynecol. 2016;215(3):310.e1–7.CrossRef Meister MR, Cahill AG, Conner SN, Woolfolk CL, Lowder JL. Predicting obstetric anal sphincter injuries in a modern obstetric population. Am J Obstet Gynecol. 2016;215(3):310.e1–7.CrossRef
17.
Zurück zum Zitat Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin no. 198: prevention and Management of Obstetric Lacerations at vaginal delivery. Obstet Gynecol. 2018 Sep;132(3):e87–e102.CrossRef Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin no. 198: prevention and Management of Obstetric Lacerations at vaginal delivery. Obstet Gynecol. 2018 Sep;132(3):e87–e102.CrossRef
18.
Zurück zum Zitat Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3(1):32–3.CrossRef Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3(1):32–3.CrossRef
19.
Zurück zum Zitat Prokhorenkova L, Gusev G, Vorobev A, Dorogush AV, Gulin A. Catboost: unbiased boosting with categorical features. In: Proceedings of the 32nd International Conference on Neural Information Processing Systems, Montréal, QC, Canada, pp. 6639–6649 Prokhorenkova L, Gusev G, Vorobev A, Dorogush AV, Gulin A. Catboost: unbiased boosting with categorical features. In: Proceedings of the 32nd International Conference on Neural Information Processing Systems, Montréal, QC, Canada, pp. 6639–6649
20.
Zurück zum Zitat Lundberg SM, Erion G, Chen H, et al. From local explanations to global understanding with explainable AI for trees. Nature Machine Intell. 2020;2(1):56–67.CrossRef Lundberg SM, Erion G, Chen H, et al. From local explanations to global understanding with explainable AI for trees. Nature Machine Intell. 2020;2(1):56–67.CrossRef
21.
Zurück zum Zitat Valsky DV, Cohen SM, Lipschuetz M, et al. Third- or fourth-degree intrapartum anal sphincter tears are associated with Levator Ani avulsion in Primiparas. J Ultrasound Med. 2016;35(4):709–15.CrossRef Valsky DV, Cohen SM, Lipschuetz M, et al. Third- or fourth-degree intrapartum anal sphincter tears are associated with Levator Ani avulsion in Primiparas. J Ultrasound Med. 2016;35(4):709–15.CrossRef
22.
Zurück zum Zitat Ying T, Li Q, Xu L, Liu F. Hu B. three-dimensional ultrasound appearance of pelvic floor in nulliparous women and pelvic organ prolapse women. Int J Med Sci. 2012;9(10):894–900.CrossRef Ying T, Li Q, Xu L, Liu F. Hu B. three-dimensional ultrasound appearance of pelvic floor in nulliparous women and pelvic organ prolapse women. Int J Med Sci. 2012;9(10):894–900.CrossRef
23.
Zurück zum Zitat Dietz HP, Abbu A, Shek KL. The levator-urethra gap measurement: a more objective means of determining levator avulsion? Ultrasound Obstet Gynecol. 2008;32:941–5.CrossRef Dietz HP, Abbu A, Shek KL. The levator-urethra gap measurement: a more objective means of determining levator avulsion? Ultrasound Obstet Gynecol. 2008;32:941–5.CrossRef
24.
Zurück zum Zitat Dietz HP, Bhalla R, Chantarasorn V, Shek KL. Avulsion of the puborectalis muscle is associated with asymmetry of the levator hiatus. Ultrasound Obstet Gynecol. 2011;37:723–6.CrossRef Dietz HP, Bhalla R, Chantarasorn V, Shek KL. Avulsion of the puborectalis muscle is associated with asymmetry of the levator hiatus. Ultrasound Obstet Gynecol. 2011;37:723–6.CrossRef
25.
Zurück zum Zitat Hickman LC, Propst K. Accurate diagnosis and repair of obstetric anal sphincter injuries: why and how. Am J Obstet Gynecol. 2020;222(6):580.e1–580.e5. Hickman LC, Propst K. Accurate diagnosis and repair of obstetric anal sphincter injuries: why and how. Am J Obstet Gynecol. 2020;222(6):580.e1–580.e5.
Metadaten
Titel
Prediction model for obstetric anal sphincter injury using machine learning
verfasst von
Henry Hillel Chill
Joshua Guedalia
Michal Lipschuetz
Tzvika Shimonovitz
Ron Unger
David Shveiky
Gilad Karavani
Publikationsdatum
12.03.2021
Verlag
Springer International Publishing
Erschienen in
International Urogynecology Journal / Ausgabe 9/2021
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-021-04752-8

Weitere Artikel der Ausgabe 9/2021

International Urogynecology Journal 9/2021 Zur Ausgabe

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.