908 The minor criteria: a prediction model for the unplanned cesarean delivery

Abstract

With rising cesarean delivery (CD) rates in the United States and knowledge that unplanned CD carries greater risks than a planned CD or vaginal delivery, this study aims to create a prediction model for unplanned primary CD for use as an intrapartum assessment and counseling tool. A retrospective chart review was conducted to examine intrapartum events and pregnancy outcomes. Women with a singleton, cephalic gestation at ≥ 37 weeks who presented in spontaneous labor or for induction of labor (IOL) were included. Women with placental abnormalities, fetal demise, trauma, or previous CD were excluded. Statistical analysis included bivariate analyses with Fisher’s exact test and logistic regression analysis. Variables associated with CD were used in machine-learning algorithms to create a predictor model to most accurately predict CD. 1404 women met inclusion criteria with 55.6% admitted in spontaneous labor and 44.3% admitted for IOL. Intrapartum factors (i.e. cervical ripening, abnormal tracing, pitocin augmentation, scheduled IOL, including non-medically indicated IOL, abnormal fetal growth, and amniotic fluid) and antepartum factors (i.e. age, weight, and language spoken) all portended a statistically significant increased risk of CD. Based on odds ratios of these variables (Table 1), a receiver operating characteristic curve was created showing that the sum of these hypothesized risk factors can be used to predict CD in 80% cases (Figure 1). Analysis of secondary outcomes confirms that unplanned CD resulted in an increased risk of negative maternal or fetal outcomes. The proposal of “minor criteria” aimed to identify modifiable and nonmodifiable factors associated with increased probability of CD in order to create a predictor model with 80% diagnostic ability to predict unplanned CD. Future directions include validation of this intrapartum tool in multiple populations for use as an intrapartum counseling tool for risk of CD, ultimately reducing maternal and fetal complications of intrapartum CD and reducing future risk of complications from multiple CD.View Large Image Figure ViewerDownload Hi-res image Download (PPT)