Fifty Years of Sudanese Hospital-based Obstetric Outcomes and an International Partnership

Abstract

Topics: Obstetric Complications, Neonatal Morbidity and MortalityI neffective uterine contractions, malpresentation, and cephalopelvic disproportion all cause prolonged labor, which is associated with neonatal asphyxia. High birth weight increases the risk of prolonged labor and a large fetal head circumference may help in predicting prolonged labor. The authors aimed to study the association between postnatal head circumference and the incidences of prolonged labor, signs of fetal distress, and maternal distress as well as the risk for vacuum extraction and emergency cesarean sections.The authors conducted a population-based study on data collected from nulliparous patients listed in the Swedish Medical Birth Register. All women who gave birth to single infants at term (Z37 or <42 wk) between 1999 and 2008 (n = 265, 456) were included. The reference group consisted of births in which the fetal head circumference was 35 cm (the most common circumference). Diagnoses and delivery methods of the patients in the reference group were as follows: 21% of the women had prolonged labor, 11% showed signs of fetal distress, 3% showed signs of maternal distress, 15% were delivered by vacuum extraction, and 7% underwent emergency cesarean section. The mean head circumference overall was 34.8 ± 1.4 cm (median, 35.0 cm). Prolonged labor, signs of fetal distress, signs of maternal distress, or a combination were diagnosed in 94% of the vacuum extractions (20% with 2 indications) and 81% of the emergency cesarean sections (12% with 2 indications). Mean maternal age, maternal height, body mass index, and birth weight increased as fetal head circumference increased. Prolonged labor increased as fetal head circumference increased in size (14% to 38% over the range of fetal head sizes). The odds of vacuum extraction were 3.5 times higher in infants with the largest circumference compared to infants in the reference group. A large head circumference increased the risk of a vacuum extraction more than the risk of an emergency cesarean. Spontaneous vaginal delivery was more likely in fetuses with a smaller head circumference (80% in reference group with head circumference 35 cm vs. 58% in the group with head circumferences 38-41 cm).The results of this study show that large fetal head circumference is associated with increased odds for prolonged labor, fetal distress, maternal distress, vacuum extraction, and emergency cesarean delivery.