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

Buyuk, Gul Nihal; Kansu-Celik, Hatice; Kaplan, Zeynep Asli Oskovi; Kisa, Burcu; Ozel, Sule; Engin-Ustun, Yaprak

doi:10.1055/s-0041-1731378

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ginecologia e Obstetrícia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Bras. Ginecol. Obstet. 43 (06) • June 2021 • https://doi.org/10.1055/s-0041-1731378 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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 fromthe 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>360mm (OR: 34.20; 95%CI: 8.04 -145.56; p<0.001)) and<345mm (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 Csection indications.

Keywords:
cesarean section; vaginal delivery; risk factors; fetal abdominal circumference; cervical dilatation

Variable	Control group	C-Section group	p-value
	(n = 273)	(n = 227)
Age (years old) (mean ± SD)	30.24 ± 5.56	32.86 ± 6.38	< 0.001^* * p < 0.05, significant.
Gravidity, median (min-max)	3 (2–7)	3(2–8)	0.051
Parity, median (min-max)	1.2 ± 1.1	2.3 ± 1.4	0.032^* * p < 0.05, significant.
Abortion, median (min-max)	0 (0–2)	0 (0–2)	0.921
BMI (kg/m²) (mean ± SD)	31.79 ± 3.73	32.59 ± 4.64	0.032^* * p < 0.05, significant.
Gestational age at delivery (weeks) (mean ± SD)	39.06 ± 1.28	39.39 ± 1.25	0.004^* * p < 0.05, significant.
Post-term pregnancy (> 41 weeks) (n, %)	35 (12%)	47 (20%)	0.021^* * p < 0.05, significant.
Birthweight (g) (mean ± SD)	3333 ± 374	3561 ± 588	< 0.001^* * p < 0.05, significant.
SGA, n (%)	14 (5%)	21 (12%)	0.019^* * p < 0.05, significant.
LGA, n (%)	26 (10%)	57 (33%)	< 0.001^* * p < 0.05, significant.
Birthweight > 4,000 g, median (min-max)	13 (5%)	52 (23%)	< 0.001^* * p < 0.05, significant.
Apgar scores n (%)
1^st minute < 7	5 (1.8%)	16 (7%)	0.006^* * p < 0.05, significant.
5^th minute < 7	1 (0.4%)	3 (1.3%)	0.334
NICU (n, %)	7 (2.6%)	15 (6.6%)	0.048^* * p < 0.05, significant.
Smoking n (%)	40 (14%)	46 (20%)	0.121
Birthweight of previous child (g) (mean ± SD)	3,448 ± 372	3,387 ± 361	0.065
History of macrosomic birth	34 (12%)	15 (6%)	0.020^* * p < 0.05, significant.
Time interval between previous birth (years)Median (min-max)	4 (2–13)	4 (2–8)	0.735
WGDP (kg) median (min-max)	15 (10–24)	17 (8–28)	0.005^* * p < 0.05, significant.
Estimated fetal weight (g) (mean ± SD)	3351 ± 333	3639 ± 558	< 0.001^* * p < 0.05, significant.
Estimated fetal weight ≥ 4,000 g (n, %)	18 (6.6%)	65 (28.6%)	< 0.001^* * p < 0.05, significant.
BPD (mm) median (min-max)	95 (86–105)	95 (82–100)	0.188
FAC (mm) median (min-max)	339 (228–371)	349 (318–385)	< 0.001^* * p < 0.05, significant.
Cervical dilatation (cm) median (min-max)	4 (2–10)	3 (2–8)	< 0.001^* * p < 0.05, significant.
Requirement of induction (n, %)	134 (35%)	66 (22%)	0.002^* * p < 0.05, significant.
PROM (n, %)	83 (30%)	94 (45%)	0.011^* * p < 0.05, significant.
Meconium stained amnions (n, %)	17 (6%)	5 (2%)	< 0.030^* * p < 0.05, significant.

Variable	Wald	OR (95%CI)	p-value
Age > 30 years old	9.522	2.09 (1.30–3.34)	0.002^* * p < 0.05, significant.
Parity > 1	7.408	1.81 (1.18–2.71)	0.006^* * p < 0.05, significant.
BMI > 30 kg/m²	0.693	1.19 (0.76–1.86)	0.437
LGA	5.794	5.09 (1.35–19.21)	0.016^* * p < 0.05, significant.
SGA	9.641	0.32 (0.15–0.65)	0.002^* * p < 0.05, significant.
PROM	3.833	1.52 (1–2.33)	0.041^* * p < 0.05, significant.
EFW ≥ 4,000 g	0.004	1.04 (1.27–3.89)	0.951
FAC > 360 mm	22.859	34.20 (8.04—145.56)	< 0.001^* * p < 0.05, significant.
FAC < 345 mm	20.172	3.06 (1.88–5)	< 0.001^* * p < 0.05, significant.
Post-term pregnancy (> 41 weeks)	0.509	0.80 (0.44–1.45)	0.475
WGDP >15 kg	2.711	0.70 (0.46–1.07)	0.100
Cervical dilatation < 5 cm	10.525	2.12 (1.34–3.34)	0.001^* * p < 0.05, significant.

Federação Brasileira das Sociedades de Ginecologia e Obstetrícia Av. Brigadeiro Luís Antônio, 3421, sala 903 - Jardim Paulista, 01401-001 São Paulo SP - Brasil, Tel. (55 11) 5573-4919 - Rio de Janeiro - RJ - Brazil
E-mail: editorial.office@febrasgo.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence Gul Nihal Buyuk, Zekai Tahir Burak Woman’s Health, Education and Research Hospital, Talatpasa Bulvari, Hamanonu, 06130, Ankara, Turkey (e-mail: gnu@windowslive.com).