Risk factors for cesarean delivery after induction of labour in nulliparous women at 41 weeks of gestation

Abstract Background Induction of labour (IOL) is an important and common clinical procedure in obstetrics. In the current study, we evaluate predictors of vaginal delivery in both nulliparous and multiparous women in north Jordan who were induced with vaginal prostaglandins. Method A prospective study was conducted on 530 pregnant women at King Abdullah University Hospital (KAUH) in north Jordan. All pregnant mothers with singleton live fetuses, who had induction of labour (IOL) between July 2017 and June 2019, were included in the study. Mode of delivery, whether vaginal or caesarean, was the primary outcome. Several maternal and fetal variables were investigated. The safety and benefit of repeated dosage of vaginal prostaglandin E2 (PGE2) tablets, neonatal outcomes and factors that affect duration of labour were also evaluated. Pearson χ2 test was used to investigate the significance of association between categorical variables, while student’s t-test and ANOVA were applied to examine the mean differences between categorical and numerical variables. Linear regression analysis was utilized to study the relation between two continuous variables. A multivariate regression analysis was then performed. Significance level was considered at alpha less than 0.05. Results Nulliparous women (N = 254) had significantly higher cesarean delivery rate (58.7% vs. 17.8%, p < 0.001) and longer duration of labour (16.1 ± 0.74 h vs. 11.0 ± 0.43 h, p < 0.001) than multiparous women (N = 276). In nulliparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop score; the mean Bishop score was 3.47 ± 0.12 in nulliparous women who had vaginal delivery vs. 3.06 ± 0.10 in women who had cesarean delivery (Adjusted odds ratio (AOR) = 1.2, 95% CI: 1.03–1.28, p = 0.03). In multiparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop scores and lower in women with higher body mass index (BMI). The mean Bishop score was 3.97 ± 0.07 in multiparous women who had vaginal delivery vs. 3.56 ± 0.16 in women who had cesarean delivery (AOR = 1.5, 95% CI: 1.1–2.1, p = 0.01). The mean BMI was 30.24 ± 0.28 kg/m2 in multiparous women who had vaginal delivery vs. 32.36 ± 0.73 kg/m2 in women who had cesarean delivery (AOR = 0.89, 95% CI: 0.84–0.96, p = 0.005). 27% of nulliparous women who received more than two PGE2 tablets and 50% of multiparous women who received more than two PGE2 tablets had vaginal delivery with no significant increase in neonatal morbidity. Conclusion Parity and cervical status are the main predictors of successful labour induction. Further studies are required to investigate the benefit of the use of additional doses of vaginal PGE2 above the recommended dose for IOL.

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Risk factors for Caesarean delivery after induction of labour among nulliparous women at term

10.12809/hkjgom.20.1.06 ◽

2020 ◽

Vol 20 (1) ◽

pp. 27-31

Author(s):

Selina Tsz-Ching Lee ◽

Winnie Wai-Yan Yeung ◽

Kwok-Yin Leung

Keyword(s):

Risk Factors ◽

Caesarean Delivery ◽

Induction Of Labour ◽

Nulliparous Women

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Disparate Rates of Cesarean Delivery in Term Nulliparous Women with Hypertensive Disorders of Pregnancy

American Journal of Perinatology ◽

10.1055/s-0039-1681057 ◽

2019 ◽

Vol 36 (10) ◽

pp. 997-1001 ◽

Cited By ~ 1

Author(s):

Christina A. Penfield ◽

Michael P. Nageotte ◽

Deborah A. Wing

Keyword(s):

Risk Factors ◽

Cesarean Delivery ◽

Significant Risk ◽

Significant Risk Factor ◽

Target Population ◽

Vital Statistics ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Important Target ◽

Nulliparous Women

Objective To evaluate the prevalence of cesarean delivery in women with hypertensive disorders of pregnancy (HDP), and explore whether maternal, sociodemographic, or obstetric comorbidities contribute to cesarean delivery rates. Study Design This is a retrospective cohort study of nulliparous, term, singleton, vertex women using the 2013 U.S. National Vital Statistics Report. We compared prevalence of risk factors for cesarean delivery between women with and without HDP, and then calculated probabilities of cesarean delivery after controlling for these risk factors. Results In this cohort of 1,439,977 women, the unadjusted probability of cesarean delivery in women with HDP was 39.5 versus 26.8% in those without the diagnosis (p < 0.01). Hypertensive women had more risk factors for cesarean delivery, most notably morbid obesity (9.0 vs. 3.1%, p < 0.01), diabetes (9.9 vs. 4.4%, p < 0.01), and induction of labor (59.2 vs. 26.9%, p < 0.01). Despite this, after controlling for these risk factors, hypertensive women remained significantly more likely to undergo cesarean delivery (35.1 vs. 26.4%, p < 0.01). Conclusion Even after controlling for multiple comorbidities, hypertension remained a significant risk factor for cesarean delivery in nulliparous women at term. Hypertensive women may therefore represent an important target population in efforts aimed at reduction of cesarean rates.

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Risk Factors for Cesarean Delivery after Induction of Labor in Nulliparous Women with an Unfavorable Cervix at or beyond 41 Weeks of Gestation

Gynecologic and Obstetric Investigation ◽

10.1159/000350798 ◽

2013 ◽

Vol 76 (4) ◽

pp. 254-259 ◽

Cited By ~ 8

Author(s):

Ga Hyun Son ◽

Jeong Hyeon Kim ◽

Ja Young Kwon ◽

Young Han Kim ◽

Yong Won Park

Keyword(s):

Risk Factors ◽

Cesarean Delivery ◽

Induction Of Labor ◽

Nulliparous Women ◽

Unfavorable Cervix

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The Active Management of Impending Cephalopelvic Disproportion in Nulliparous Women at Term: A Case Series

Journal of Pregnancy ◽

10.1155/2010/708615 ◽

2010 ◽

Vol 2010 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

James M. Nicholson ◽

Lisa C. Kellar

Keyword(s):

Risk Factors ◽

Cesarean Delivery ◽

Birth Outcome ◽

Mode Of Delivery ◽

Case Series ◽

Active Management ◽

Optimal Time ◽

Cephalopelvic Disproportion ◽

Nulliparous Women ◽

The Impact

Background. The Active Management of Risk in Pregnancy at Term (AMOR-IPAT) protocol has been associated in several studies with significant reductions of group cesarean delivery rate. Present within each of these studies were nulliparous women with risk factors for cephalopelvic disproportion. Risk factors for cephalopelvic disproportion in nulliparous women are especially important because they represent the precursors for the most common indication for primary cesarean delivery.Cases. Three examples of exposure of urban nulliparous women to the AMOR-IPAT protocol are presented. Each woman's risk factor profile for Cephalopelvic Disproportion (CPD) was used to estimate her Upper Limit of Optimal Time of Vaginal Delivery for CPD (UL-OTDcpd). Labor management and clinical outcomes for each case are presented. A simple table summarizing induction rates and birth outcome rates of exposed versus nonexposed nulliparous women is also presented.Conclusion. Because the mode of delivery of the first birth substantially impacts birth options in later pregnancies, the impact of AMOR-IPAT on nulliparous patients is particularly important. Determining the UL-OTDcpd in nulliparous patients, and carefully inducing each patient who has not entered labor by her UL-OTDcpd, may be an effective way of lowering rates of cesarean delivery in nulliparous women.

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The Association between Maternal Race and Ethnicity and Risk Factors for Primary Cesarean Delivery in Nulliparous Women

American Journal of Perinatology ◽

10.1055/s-0039-1697587 ◽

2019 ◽

Author(s):

Elisabeth L. Stark ◽

William A. Grobman ◽

Emily S. Miller

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Black Women ◽

Cesarean Delivery ◽

White Women ◽

Ethnic Disparities ◽

Nulliparous Women ◽

Race Ethnicity ◽

Racial Ethnic ◽

Hispanic White

Abstract Objective To understand whether maternal, perinatal, and systems-level factors can be identified to explain racial/ethnic disparities in cesarean delivery rates. Study Design This retrospective cohort study included nulliparous women with singleton gestations who delivered at a tertiary care center from 2015 to 2017. Maternal, perinatal, and systems-level factors were compared by race/ethnicity. Multilevel multivariable logistic regression was used to identify whether race/ethnicity was independently associated with cesarean. Effect modification was evaluated using interaction terms. Bivariable analyses and multinomial logistic regression were used to determine differences in indication for cesarean. Results Of 9,865 eligible women, 2,126 (21.5%) delivered via cesarean. The frequency of cesarean was lowest in non-Hispanic white women (19.2%) and highest in non-Hispanic black women (28.2%; p < 0.001). Accounting for factors associated with cesarean delivery did not lessen the odds of cesarean associated with non-Hispanic black race (aOR: 1.58, 95% CI: 1.31–1.91). Compared with non-Hispanic white women, non-Hispanic black women were more likely to undergo cesarean for nonreassuring fetal status (aOR: 2.73, 95% CI: 2.06–3.61). Conclusion Examined maternal, perinatal, and systems-level risk factors for cesarean delivery did not explain the racial/ethnic disparities observed in cesarean delivery rates. Increased cesarean delivery for nonreassuring fetal status contributed substantially to this disparity.

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