Intrapartum cesarean delivery in nulliparas: risk factors compared by two analytical approaches

Kominiarek, Michelle A.; VanVeldhuisen, Paul; Gregory, Kimberly D.; Fridman, Moshe; Kim, Hajwa; Hibbard, Judith U.

doi:10.1038/jp.2014.179

Cited by 19 publications

(32 citation statements)

References 28 publications

(35 reference statements)

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“…Overweight or obese women entering pregnancy are at risk for delivery through CSand excessive gestational weight gain also increases the overall likelihood of CS as well as intrapartum CS . Intrapartum BMI can also affect the likelihood of intrapartum CS . We demonstrated that increases in pre‐pregnancy BMI, gestational weight gain, and intrapartum BMI were associated with a decreased likelihood of VD.…”

Section: Discussionmentioning

confidence: 66%

“…While the impact of maternal age, pre‐pregnancy body mass index (BMI), BMI upon admission, cervical dilation and fetal weight on intrapartum CS have been reported previously, no well‐developed or widely accepted vaginal delivery (VD) prediction models exist. Because prenatal factors play a greater role in CS than intrapartum factors do, an understanding of these factors would aid informed clinical decision‐making.…”

Section: Introductionmentioning

confidence: 99%

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Building a predictive model for successful vaginal delivery in nulliparas with term cephalic singleton pregnancies using decision tree analysis

Zhao

Zhang

Zhou

et al. 2019

J of Obstet and Gynaecol

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Aim: To establish a model predicting successful vaginal delivery (VD) in nulliparas with term cephalic singleton pregnancies. Methods: We retrospectively identified 6799 term nulliparas with cephalic singletons (6416 VD and 383 cesarean section [CS] due to dystocia) who entered labor (cervical dilation ≥2 cm) between September 2014 and August 2015. Using VD as the dependent variable and age, maternal body height, educational attainment, gravidity, gestational age, pre-pregnancy body mass index (BMI), BMI upon admission for delivery, gestational weight gain, gestational hypertension and gestational diabetes as the independent variables, predictors of VD success were identified using a multivariate binary logistic regression and then ranked with decision-tree analysis. Results: While multiple factors are associated with improved VD success, we found body height, gestational age, and intrapartum BMI to be the best predictors of successful VD. Our predictive model has a classification accuracy, sensitivity and specificity of 76.6%, 96.7% and 16.4%, respectively, and it was subsequently confirmed by both internal and external validation. Conclusion: Our predictive model indicates body height, gestational age and intrapartum BMI as the major predictors of successful VD in low-risk patients.

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Section: Discussionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Building a predictive model for successful vaginal delivery in nulliparas with term cephalic singleton pregnancies using decision tree analysis

Zhao

Zhang

Zhou

et al. 2019

J of Obstet and Gynaecol

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“…1 Despite this, labor processes and outcomes of parous women have been less thoroughly characterized than those of nulliparous women. 2,3 Evidence suggests that the hospital in which an otherwise healthy woman gives birth is a factor independently affecting maternal and neonatal outcomes. 4,5 Midwifery care has been associated with improved outcomes for healthy, low-risk women.…”

Section: Introductionmentioning

confidence: 99%

Influence of midwifery presence in United States centers on labor care and outcomes of low‐risk parous women: A Consortium on Safe Labor study

Carlson

Neal

Tilden

et al. 2018

Birth

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Background: Sixty percent of United States births are to multiparous women. Hospitallevel policies and culture may influence intrapartum care and birth outcomes for this large population, yet have been poorly explored using a large, diverse sample. We sought to use national United States data to analyze the association between midwifery presence in maternity care teams and the birth processes and outcomes of low-risk parous women. Methods: We conducted a retrospective cohort study using Consortium on Safe Labor data from low-risk parous women in either interprofessional care (n = 12 125) or noninterprofessional care centers (n = 8996). Unadjusted, adjusted (age, race, health insurance type), propensity-adjusted, and propensity-matched logistic regression models were used to assess processes and outcomes. Results: There was concordance in outcome differences across regression models. With propensity score matching, women at interprofessional centers, compared with women at noninterprofessional centers, were 85% less likely to have labor induced (risk ratio [RR] 0.15; 95% CI 0.14-0.17). The risk for primary cesarean birth among low-risk parous women was 36% lower at interprofessional centers (RR 0.64; 95% CI 00.52-0.79), whereas the likelihood of vaginal birth after cesarean for this population was 31% higher (RR 1.31; 95% CI 1.10-1.56). There were no significant differences in neonatal outcomes. Conclusions: Parous women have significantly higher rates of vaginal birth, including vaginal birth after cesarean, and lower likelihood of labor induction when cared for in centers with midwives. Our findings are consistent with smaller analyses of midwifery practice and support integrated, team-based models of perinatal care to improve maternal outcomes. K E Y W O R D Scesarean, culture, induced labor, midwifery, multiparous, obstetrics, oxytocin, parturition 488 | CARLSON et AL.

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“…1,4 Large retrospective cohort studies have demonstrated that the risk of primary cesarean delivery increases with increasing maternal BMI. 2,[4][5][6][7] The risk of cesarean delivery increases in a dose-response manner, and women in the highest obesity class (BMIZ40 kg/m 2 ) are 3-to 5-fold more likely to have a primary cesarean delivery thannormal-weightwomen (BMI<25 kg/ m 2 ) ( Table 1). 2,6,7 Although many studies use prepregnancy or first-trimester BMI to classify women as overweight or obese, the increased risk of cesarean delivery is evident even in women who were classified as overweight (BMI = 25 to 29.9 kg/m 2 ) only at the time of delivery [adjusted odds ratio (aOR) = 1.6; 95% confidence interval (CI), 1.5-1.7].…”

Section: Cesarean Deliverymentioning

confidence: 97%

“…2,6,7 Although many studies use prepregnancy or first-trimester BMI to classify women as overweight or obese, the increased risk of cesarean delivery is evident even in women who were classified as overweight (BMI = 25 to 29.9 kg/m 2 ) only at the time of delivery [adjusted odds ratio (aOR) = 1.6; 95% confidence interval (CI), 1.5-1.7]. 7 In addition, women of all weight classes with gestational weight gain greater than that recommended by the Institute of Medicine are at higher risk of cesarean delivery. 8 Obese women (BMIZ30 kg/m 2 ) who gain >20 lb during their pregnancy are 1.5 times more likely to have a cesarean delivery than those whose gestational weight gain is not excessive.…”

Section: Cesarean Deliverymentioning

confidence: 98%

Delivery of the Obese Gravida

Faucett

Metz

2016

Clinical Obstetrics &Amp; Gynecology

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Obesity in pregnancy confers morbidity to both the mother and neonate. Obese women are at increased risk of cesarean delivery, operative vaginal delivery, and failed trial of labor after cesarean delivery. In addition to impacting the mode of delivery, obesity is associated with hemorrhage, infection, and thromboembolic complications intheperipartumperiod. The risk of these complications increases with increasing maternal body mass index. In this chapter, we discuss evidence-based strategies to mitigate these risks and to manage complications that occur at the time of delivery in obese parturients.

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Intrapartum cesarean delivery in nulliparas: risk factors compared by two analytical approaches

Cited by 19 publications

References 28 publications

Building a predictive model for successful vaginal delivery in nulliparas with term cephalic singleton pregnancies using decision tree analysis

Building a predictive model for successful vaginal delivery in nulliparas with term cephalic singleton pregnancies using decision tree analysis

Influence of midwifery presence in United States centers on labor care and outcomes of low‐risk parous women: A Consortium on Safe Labor study

Delivery of the Obese Gravida

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