Prediction of difficult vaginal birth and of cesarean section for cephalopelvic disproportion in early labor.

Abstract

A total of 1,692 patients were evaluated in early labor, and predictions were made for easy labor-vaginal birth, difficult labor-vaginal birth, or improbable vaginal birth-cesarean section. The prediction was based on clinical evaluation of pelvic dimensions, and fetal measurements by sonography at term. The combined prediction that a patient would have either a difficult labor-vaginal birth or cesarean section was very accurate (362 out of 370, or 97.8%). However, the separate prediction of difficult labor-vaginal birth and a cesarean section was less accurate, although still significant (73.4% and 90.2%, respectively). A similar study on 141 vaginal birth after cesarean (VBAC) candidates showed that by sectioning electively patients in whom cesarean sections were predicted, the cesarean section rate barely increased. Careful evaluation of a patient in early labor could help to recognize the dystocic labor-delivery and early indication for cesarean sections. This would avoid unnecessary and prolonged labor without necessarily increasing the cesarean section rate.