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

Abstract

Objective 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. Methods 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. Results 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. Conclusion 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.

Labour analgesia by single shot spinal for any parturient?—A retrospective one‐year single centre audit

“…Finally, the risk for operative delivery is higher in primiparous parturients compared to multiparous parturients, particularly those whose labour is progressing well 16,17 . The use of catheter‐based analgesia methods, such as epidural or CSE analgesia, would facilitate topping up of the labour analgesia to provide safe and effective anaesthesia for most peripartum operative needs 18 …”

“…Finally, the risk for operative delivery is higher in primiparous parturients compared to multiparous parturients, particularly those whose labour is progressing well. 16,17 The use of catheter-based analgesia methods, such as epidural or CSE analgesia, would facilitate topping up of the labour analgesia to provide safe and effective anaesthesia for most peripartum operative needs. 18 This is a retrospective study and therefore it has some limitations, including potential underreporting of either initial pain after the SSS intervention or recurrent pain after the effect of SSS has worn off.…”

Association between asymptomatic infections and linear growth in 18–24‐month‐old Malawian children

“…Our conceptual model (Supporting Information: Figure 1 ) was based on widely adopted frameworks that include contextual factors, intermediate variables, and proximal determinants of the child's nutritional status (Black et al, 2008 ; Buyuk et al, 2021 ; Stewart et al, 2013 ). We included household assets and parental education as factors reflecting the environmental and socioeconomic context.…”

Development and validation of a prediction model for intrapartum cesarean delivery based on the artificial neural networks approach: a protocol for a prospective nested case–control study

“…It is also associated with hypoglycaemia, low Apgar scores, higher neonatal intensive care unit admission, asthma and respiratory distress in newborns 7–9. Previous studies indicated that some risk factors (eg, macrosomia, maternal obesity during pregnancy) for intrapartum caesarean delivery could be handled or avoided 10 11. Identifying the risk factors and reducing unnecessary intrapartum caesarean is thus a concern for medical professionals across the world.…”