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J Perinatol. 2015 Mar;35(3):167-72. doi: 10.1038/jp.2014.179. Epub 2014 Sep 25.

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

Author information

1
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA.
2
The EMMES Corporation, Rockville, MD, USA.
3
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
4
AMF Consulting, Los Angeles, CA, USA.
5
University of Illinois at Chicago Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, IL, USA.
6
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA.

Abstract

OBJECTIVE:

To determine risk factors for cesarean delivery in nulliparas at labor admission.

STUDY DESIGN:

Nulliparas with live-born, singleton gestations ⩾37 weeks in spontaneous or induced labor were analyzed from the Consortium on Safe Labor database in a retrospective observational study. Classification and regression tree (CART) and multivariate logistic regression analysis determined risk factors for cesarean delivery.

RESULT:

Of the 66 539 nulliparas, 22% had a cesarean delivery. In the CART analysis, the first cervical dilation exam was the first branch followed by body mass index (BMI). Cesarean deliveries occurred in 45%, 25%, 14% and 10% of deliveries at <1, 1 to 3, 4 and ⩾5 cm dilated, respectively. The BMI influence was most evident in the <1 cm dilation category with 26% of BMI <25 kg m(-2) and 66% of BMI ⩾40 kg m(-2) having a cesarean delivery. The fewest cesarean deliveries (5%) occurred in those ⩾5 cm and BMI <25 kg m(-2). In the multivariate regression analysis, first cervical dilation exam <1 cm (odds ratio (OR) 5.1, 95% confidence interval (CI): 4.5 to 5.7; reference ⩾5 cm) and BMI ⩾40 kg m(-2) (OR 5.1, 95% CI: 4.6 to 5.7; reference BMI <25.0 kg m(-2)) had the highest odds for cesarean delivery.

CONCLUSION:

Cervical dilation on admission followed by BMI were the two most important risk factors for cesarean delivery identified in both CART and multivariate regression analysis.

PMID:
25254334
PMCID:
PMC4342275
DOI:
10.1038/jp.2014.179
[Indexed for MEDLINE]
Free PMC Article

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