{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T06:09:05Z","timestamp":1789193345493,"version":"build-2803163510"},"reference-count":34,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"University of Ottawa Department of Family Medicine Program for Research and Innovation in Primary Care and Medical Education","award":["20-939502000"],"award-info":[{"award-number":["20-939502000"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,8]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"\n Objective<\/jats:title>\n To develop and internally validate a clinical prediction model estimating the probability of emergency caesarean delivery among low-risk pregnancies using routinely available intrapartum variables. The model is intended to support clinicians in recommending transfer decisions in rural obstetric settings without onsite caesarean capacity.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Retrospective cohort study with multivariable logistic regression and internal validation using bootstrap resampling.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Province-wide birth registry in Ontario, Canada.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Singleton, hospital births from low-risk pregnancies between 1 April 2012 and 31 March 2020, captured in the Better Outcomes Registry and Network Ontario. Exclusions included previous caesarean, major comorbidities and other high-risk conditions.<\/jats:p>\n <\/jats:sec>\n \n Primary outcome<\/jats:title>\n Emergency caesarean delivery during labour.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 611 644 low-risk pregnancies, 66 482 (10.9%) resulted in emergency caesarean delivery. Key predictors included abnormal fetal health surveillance, nulliparity, gestational hypertension, polyhydramnios area under the receiver operating characteristic curve (AUC) and oxytocin augmentation. The optimism-corrected AUC was 0.86, indicating strong discrimination. Calibration was generally good, though the model underestimated caesarean risk in patients first admitted to level I hospitals.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This study presents a proof-of-concept prototype with strong discrimination, though calibration of the full model was suboptimal in level I hospitals, the intended setting for application. While not clinically deployable in its current form, the model lays the groundwork for a translational pathway that will require local recalibration, external validation and contextual adaptation before implementation. Threshold-based clinical utility (eg, positive\/negative predictive value or net benefit) was not assessed and will be evaluated during external validation and local recalibration.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110073","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T05:15:24Z","timestamp":1789190124000},"page":"e110073","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Development and internal validation of an intrapartum caesarean risk prediction model to guide rural obstetric transfer decisions: a population-based study using BORN Ontario data"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1207-8609","authenticated-orcid":false,"given":"Kheira","family":"Jolin-Dahel","sequence":"first","affiliation":[{"name":"Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada"},{"name":"Department of Family Medicine, Winchester District Memorial Hospital, Winchester, Hampshire, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Hawken","sequence":"additional","affiliation":[{"name":"The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"},{"name":"School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liam","family":"Bruce","sequence":"additional","affiliation":[{"name":"Better Outcomes Registry and Network (BORN) Ontario, Ottawa, Ontario, Canada"},{"name":"Children\u2019s Hospital of Eastern Ontario, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"2026091122151348000_16.9.e110073.1","unstructured":"Canadian Institute for Health Information (CIHI) . 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