Intrapartum cesarean delivery in nulliparas: risk factors compared by two analytical approaches. J Perinatol 2015 Mar;35(3):167-72
Date
09/26/2014Pubmed ID
25254334Pubmed Central ID
PMC4342275DOI
10.1038/jp.2014.179Scopus ID
2-s2.0-84964698308 (requires institutional sign-in at Scopus site) 17 CitationsAbstract
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.
Author List
Kominiarek MA, VanVeldhuisen P, Gregory K, Fridman M, Kim H, Hibbard JUMESH terms used to index this publication - Major topics in bold
AdultBody Mass Index
Cesarean Section
Delivery, Obstetric
Female
Gestational Age
Humans
Labor, Induced
Labor, Obstetric
Logistic Models
Multivariate Analysis
Odds Ratio
Parity
Pregnancy
Retrospective Studies
Risk Factors
Young Adult
