Risk Factors for Intrapartum Cesarean Section Delivery in Low-risk Multiparous Women Following at Least a Prior Vaginal Birth (Robson Classification 3 and 4).

Sule Ozel,Burcu Kisa,Yaprak Engin-Ustun,Zeynep Asli Oskovi Kaplan,Gul Nihal Buyuk,Hatice Kansu-Celik

doi:10.1055/s-0041-1731378

Abstract

The aim of the present study was to evaluate the risk factors for cesarean section (C-section) in low-risk multiparous women with a history of vaginal birth. The present retrospective study included low-risk multiparous women with a history of vaginal birth who gave birth at between 37 and 42 gestational weeks. The subjects were divided into 2 groups according to the mode of delivery, as C-section Group and vaginal delivery Group. Risk factors for C-section such as demographic characteristics, ultrasonographic measurements, smoking, weight gain during pregnancy (WGDP), interval time between prior birth, history of macrosomic birth, and cervical dilatation at the admission to the hospital were obtained from the charts of the patients. Obstetric and neonatal outcomes were compared between groups. The most common C-section indications were fetal distress and macrosomia (33.9% [n = 77 and 20.7% [n = 47] respectively). A bivariate correlation analysis demonstrated that mothers aged > 30 years old (odds ratio [OR]: 2.09; 95% confidence interval [CI]: 1.30-3.34; p = 0.002), parity >1 (OR: 1.81; 95%CI: 1.18-2.71; p = 0.006), fetal abdominal circumference (FAC) measurement > 360 mm (OR: 34.20; 95%CI: 8.04-145.56; p < 0.001)) and < 345 mm (OR: 3.06; 95%CI: 1.88-5; p < 0.001), presence of large for gestational age (LGA) fetus (OR: 5.09; 95%CI: 1.35-19.21; p = 0.016), premature rupture of membranes (PROM) (OR: 1.52; 95%CI: 1-2.33; p = 0.041), and cervical dilatation < 5cm at admission (OR: 2.12; 95%CI: 1.34-3.34; p = 0.001) were associated with the group requiring a C-section. This is the first study evaluating the risk factors for C-section in low-risk multiparous women with a history of vaginal birth according to the Robson classification 3 and 4. Fetal distress and suspected fetal macrosomia constituted most of the C-section indications.

Highlights

Increasing cesarean section (C-section) rates are becoming a concern especially in countries with higher C-section rates
A bivariate correlation analysis demonstrated that mothers aged > 30 years old, parity >1 (OR: 1.81; 95%CI: 1.18–2.71; p 1⁄4 0.006), fetal abdominal circumference (FAC) measurement > 360 mm (OR: 34.20; 95%CI: 8.04 —145.56; p < 0.001)) and < 345 mm (OR: 3.06; 95%CI: 1.88–5; p < 0.001), presence of large for gestational age (LGA) fetus (OR: 5.09; 95%CI: 1.35–19.21; p 1⁄4 0.016), premature rupture of membranes (PROM) (OR: 1.52; 95%CI: 1–2.33; p 1⁄4 0.041), and cervical dilatation < 5cm at admission (OR: 2.12; 95%CI: 1.34–3.34; p 1⁄4 0.001) were associated with the group requiring a C-section
This is the first study evaluating the risk factors for C-section in low-risk multiparous women with a history of vaginal birth according to the Robson classification 3 and 4

Summary

Introduction

Increasing cesarean section (C-section) rates are becoming a concern especially in countries with higher C-section rates. The C-section rates have increased gradually in recent years, especially in middle- and high-income countries, without any increase in indications or strict medical reasons.. In Turkey, the C-section rate among all deliveries has increased from 21% in 2012 to 53% in 2015.3 Various reasons for why mothers and obstetricians prefer C-section have been postulated for this increase, including prior C-section deliveries, advanced maternal age, systemic diseases such as hypertension and diabetes mellitus, multiple pregnancies, fetal distress, macrosomic fetus, malpresentation of fetus, cephalopelvic disproportion, prolonged labor, and insufficient supplementary health network.. Chronic health problems, multiple pregnancies as a result of the development of assisted reproductive technologies, and an insufficient supplementary health network can be considered as the reasons why mothers and obstetricians prefer a C-section.. We aimed to demonstrate the risk factors for intrapartum C-section in low-risk women with a history of vaginal birth

Methods

Results

Conclusion