Risk Factors for Intrapartum Cesarean Section Delivery in Low-risk Multiparous Women Following at Least a Prior Vaginal Birth (Robson Classification 3 and 4)

 

 Permissions and Reprints

Abstract

Objective The aim of the present study was to evaluate the risk factors for cesarean section (C-section) in low-risk multiparous women with a history of vaginal birth.

Methods The present retrospective study included low-risk multiparous women with a history of vaginal birth who gave birth at between 37 and 42 gestational weeks. The subjects were divided into 2 groups according to the mode of delivery, as C-section Group and vaginal delivery Group. Risk factors for C-section such as demographic characteristics, ultrasonographic measurements, smoking, weight gain during pregnancy (WGDP), interval time between prior birth, history of macrosomic birth, and cervical dilatation at the admission to the hospital were obtained from the charts of the patients. Obstetric and neonatal outcomes were compared between groups.

Results The most common C-section indications were fetal distress and macrosomia (33.9% [n = 77 and 20.7% [n = 47] respectively). A bivariate correlation analysis demonstrated that mothers aged > 30 years old (odds ratio [OR]: 2.09; 95% confidence interval [CI]: 1.30–3.34; p = 0.002), parity >1 (OR: 1.81; 95%CI: 1.18–2.71; p = 0.006), fetal abdominal circumference (FAC) measurement > 360 mm (OR: 34.20; 95%CI: 8.04—145.56; p < 0.001)) and < 345 mm (OR: 3.06; 95%CI: 1.88–5; p < 0.001), presence of large for gestational age (LGA) fetus (OR: 5.09; 95%CI: 1.35–19.21; p = 0.016), premature rupture of membranes (PROM) (OR: 1.52; 95%CI: 1–2.33; p = 0.041), and cervical dilatation < 5cm at admission (OR: 2.12; 95%CI: 1.34–3.34; p = 0.001) were associated with the group requiring a C-section.

Conclusion This is the first study evaluating the risk factors for C-section in low-risk multiparous women with a history of vaginal birth according to the Robson classification 3 and 4. Fetal distress and suspected fetal macrosomia constituted most of the C-section indications.

Contributors

All authors were involved in the design and interpretation of the analyses, contributed to the writing of the manuscript, read and approved the final manuscript.

Publication History

Received: 16 June 2020

Accepted: 19 February 2021

Article published online:
27 July 2021

© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

• References

• 1 Vercellini P, De Giorgi O, Pisacreta A, Pesole AP, Vicentini S, Crosignani PG. Surgical management of endometriosis. Best Pract Res Clin Obstet Gynaecol 2000; 14 (03) 501-523 DOI: 10.1053/beog.1999.0088.
  CrossrefPubMedGoogle Scholar
• 2 Khooshide M, Mirzarahimi T, Akhavan Akbari G. The impact of physiologic and non-physiologic delivery on the mother and neonate outcomes; a comparative study on the primi gravid mothers. J Family Reprod Health 2015; 9 (01) 13-18
  PubMedGoogle Scholar
• 3 Betran AP, Torloni MR, Zhang JJ, Gülmezoglu AM. WHO Working Group on Caesarean Section. WHO Statement on Caesarean Section Rates. BJOG 2016; 123 (05) 667-670 DOI: 10.1111/1471-0528.13526.
  CrossrefPubMedGoogle Scholar
• 4 Ministry of Health. Turkey Health Statistics Yearbook 2015. Ankara: General Directorate for Health Research (SAGEM); 2015
  Google Scholar
• 5 Ferrari AP, Carvalhaes MA, Parada CM. Association between prenatal and parturition in the supplementary health network and elective cesarean section. Rev Bras Epidemiol 2016; 19 (01) 75-88 DOI: 10.1590/1980-5497201600010007.
  CrossrefPubMedGoogle Scholar
• 6 Betrán AP, Vindevoghel N, Souza JP, Gülmezoglu AM, Torloni MR. A systematic review of the Robson classification for caesarean section: what works, doesn't work and how to improve it. PLoS One 2014; 9 (06) e97769 DOI: 10.1371/journal.pone.0097769.
  CrossrefPubMedGoogle Scholar
• 7 Practice Bulletins No. Practice bulletins No. 139: premature rupture of membranes. Obstet Gynecol 2013; 122 (04) 918-930 DOI: 10.1097/01.AOG.0000435415.21944.8f.
  CrossrefPubMedGoogle Scholar
• 8 March MI, Warsof SL, Chauhan SP. Fetal biometry: relevance in obstetrical practice. Clin Obstet Gynecol 2012; 55 (01) 281-287 DOI: 10.1097/GRF.0b013e3182446e9b.
  CrossrefPubMedGoogle Scholar
• 9 Mazzoni A, Althabe F, Liu NH, Bonotti AM, Gibbons L, Sánchez AJ. et al. Women's preference for caesarean section: a systematic review and meta-analysis of observational studies. BJOG 2011; 118 (04) 391-399 DOI: 10.1111/j.1471-0528.2010.02793.x.
  CrossrefPubMedGoogle Scholar
• 10 Chiofalo B, Laganà AS, Vaiarelli A, La Rosa VL, Rossetti D, Palmara V. et al. Do miRNAs play a role in fetal growth restriction? A fresh look to a busy corner. BioMed Res Int 2017; 2017: 6073167 DOI: 10.1155/2017/6073167.
  CrossrefPubMedGoogle Scholar
• 11 Lindstad Løvåsmoen EM, Nyland Bjørgo M, Lukasse M, Schei B, Henriksen L. Women's preference for caesarean section and the actual mode of delivery - Comparing five sites in Norway. Sex Reprod Healthc 2018; 16: 206-212 DOI: 10.1016/j.srhc.2018.04.009.
  CrossrefPubMedGoogle Scholar
• 12 Ennen CS, Bofill JA, Magann EF, Bass JD, Chauhan SP, Morrison JC. Risk factors for cesarean delivery in preterm, term and post-term patients undergoing induction of labor with an unfavorable cervix. Gynecol Obstet Invest 2009; 67 (02) 113-117 DOI: 10.1159/000166307.
  CrossrefPubMedGoogle Scholar
• 13 Gerli S, Favilli A, Franchini D, De Giorgi M, Casucci P, Parazzini F. Is the Robson's classification system burdened by obstetric pathologies, maternal characteristics and assistential levels in comparing hospitals cesarean rates? A regional analysis of class 1 and 3. J Matern Fetal Neonatal Med 2018; 31 (02) 173-177 DOI: 10.1080/14767058.2017.1279142.
  CrossrefPubMedGoogle Scholar
• 14 Ben-Haroush A, Yogev Y, Bar J, Glickman H, Kaplan B, Hod M. Indicated labor induction with vaginal prostaglandin E2 increases the risk of cesarean section even in multiparous women with no previous cesarean section. J Perinat Med 2004; 32 (01) 31-36 DOI: 10.1515/JPM.2004.005.
  CrossrefPubMedGoogle Scholar
• 15 Rahnama P, Ziaei S, Faghihzadeh S. Impact of early admission in labor on method of delivery. Int J Gynaecol Obstet 2006; 92 (03) 217-220 DOI: 10.1016/j.ijgo.2005.12.016.
  CrossrefPubMedGoogle Scholar
• 16 Kauffman E, Souter VL, Katon JG, Sitcov K. Cervical dilation on admission in term spontaneous labor and maternal and newborn outcomes. Obstet Gynecol 2016; 127 (03) 481-488 DOI: 10.1097/AOG.0000000000001294.
  CrossrefPubMedGoogle Scholar
• 17 Zhang J, Troendle J, Mikolajczyk R, Sundaram R, Beaver J, Fraser W. The natural history of the normal first stage of labor. Obstet Gynecol 2010; 115 (04) 705-710 DOI: 10.1097/AOG.0b013e3181d55925.
  CrossrefPubMedGoogle Scholar
• 18 Holmes P, Oppenheimer LW, Wen SW. The relationship between cervical dilatation at initial presentation in labour and subsequent intervention. BJOG 2001; 108 (11) 1120-1124 DOI: 10.1111/j.1471-0528.2003.00265.x.
  CrossrefPubMedGoogle Scholar
• 19 Bailit JL, Dierker L, Blanchard MH, Mercer BM. Outcomes of women presenting in active versus latent phase of spontaneous labor. Obstet Gynecol 2005; 105 (01) 77-79 DOI: 10.1097/01.AOG.0000147843.12196.00.
  CrossrefPubMedGoogle Scholar
• 20 Wood AM, Frey HA, Tuuli MG, Caughey AB, Odibo AO, Macones GA. et al. Optimal admission cervical dilation in spontaneously laboring women. Am J Perinatol 2016; 33 (02) 188-194 DOI: 10.1055/s-0035-1563711.
  Article in Thieme ConnectPubMedGoogle Scholar
• 21 Çelik HG, Bestel A, Çelik E, Aydın AA. Why do multiparous women with a history of vaginal delivery give birth by cesarean section?. J Turk Ger Gynecol Assoc 2016; 17 (04) 209-213 DOI: 10.5152/jtgga.2016.16119.
  CrossrefPubMedGoogle Scholar
• 22 Parer JT, Livingston EG. What is fetal distress?. Am J Obstet Gynecol 1990; 162 (06) 1421-1425 , discussion 1425–1427 DOI: 10.1016/0002-9378(90)90901-i.
  CrossrefPubMedGoogle Scholar
• 23 Yli BM, Kjellmer I. Pathophysiology of foetal oxygenation and cell damage during labour. Best Pract Res Clin Obstet Gynaecol 2016; 30: 9-21 DOI: 10.1016/j.bpobgyn.2015.05.004.
  CrossrefPubMedGoogle Scholar
• 24 Weiner Z, Ben-Shlomo I, Beck-Fruchter R, Goldberg Y, Shalev E. Clinical and ultrasonographic weight estimation in large for gestational age fetus. Eur J Obstet Gynecol Reprod Biol 2002; 105 (01) 20-24 DOI: 10.1016/s0301-2115(02)00140-9.
  CrossrefPubMedGoogle Scholar
• 25 Weeks JW, Pitman T, Spinnato II JA. Fetal macrosomia: does antenatal prediction affect delivery route and birth outcome?. Am J Obstet Gynecol 1995; 173 (04) 1215-1219 DOI: 10.1016/0002-9378(95)91356-4.
  CrossrefPubMedGoogle Scholar