Original ResearchObstetricsPrediction of cesarean delivery in the term nulliparous woman: results from the prospective, multicenter Genesis study
Section snippets
Materials and Methods
This was a prospective, multicenter, blinded observational study conducted between October 2012 and June 2015. Nulliparous women were invited to participate at each of the 7 Perinatal Ireland Research Consortium sites (Rotunda Hospital, Dublin; National Maternity Hospital, Dublin; Coombe Women and Infants University Hospital, Dublin; Galway University Hospital, Galway; University Maternity Hospital, Limerick; Cork University Maternity Hospital, Cork; and Royal Jubilee Hospital, Belfast). There
Results
The study population profile is described in Figure 1. A total of 2392 study participants were recruited. There were 56 (2.3%) participants excluded for the following reasons; lost to follow-up (n = 4), abnormal biophysical profile (n = 33), EFW < 2.5 kg or > 5 kg (n = 5), EFW performed after enrollment (n = 5), and preexisting indication for CD, such as breech presentation and placental abruption (n = 9). Therefore, a total of 2336 women were included in the final analysis, and they
Principle findings
Five parameters were identified as clinically informative in the estimation of overall risk of CD in the term nulliparous woman, namely advancing maternal age, increasing maternal BMI, shorter maternal height, larger fetal HC, and larger fetal AC, the latter blinded ultrasound-derived data obtained after 39 completed weeks’ gestation. All such parameters are either available routinely or easily obtainable. These findings are consistent with previous studies on factors contributing to increasing
Conclusion
This nomogram, using 5 parameters (maternal age, BMI, height, fetal HC, and fetal AC), has the potential to assist with individualized consultation and thereby optimal selection of women for a successful vaginal delivery. It also may serve as an audit tool for improved monitoring of primary CD rates in nulliparous women at a hospital or population level. We believe that this risk tool will be useful for reassuring most women regarding their likely success at having an uncomplicated vaginal
References (32)
- et al.
Inequities in the use of cesarean section deliveries in the world
Am J Obstet Gynecol
(2012) - et al.
Maternal morbidity associated with cesarean delivery without labor compared with spontaneous onset of labor at term
Obstet Gynecol
(2003) - et al.
Toward normal birth-but at what cost?
Am J Obstet Gynecol
(2016) - et al.
Safe prevention of the primary cesarean delivery
Am J Obstet Gynecol
(2014) - et al.
Prediction of risk for cesarean delivery in term nulliparas: a comparison of neural network and multiple logistic regression models
Am J Obstet Gynecol
(2009) - et al.
A model to predict vaginal delivery in nulliparous women based on maternal characteristics and intrapartum ultrasound
Am J Obstet Gynecol
(2015) - et al.
Changes in maternal characteristics and obstetric practice and recent increases in primary cesarean delivery
Obstet Gynecol
(2003) - et al.
Risk factors for macrosomia and its clinical consequences: a study of 350,311 pregnancies
Eur J Obstet Gynecol Reprod Biol
(2003) - et al.
Suspicion and treatment of the macrosomic fetus: a review
Am J Obstet Gynecol
(2005) - et al.
Estimated fetal weight by ultrasound: a modifiable risk factor for cesarean delivery?
Am J Obstet Gynecol
(2012)
Prognostic models in obstetrics: available, but far from applicable
Am J Obstet Gynecol
Epidural and spinal anesthesia use during labor: 27-state reporting area, 2008
Natl Vital Stat Rep
Maternal and perinatal morbidity of caesarean delivery at full cervical dilatation compared with caesarean delivery in the first stage of labour
BJOG
Prenatal risk factors for Caesarean section. Analyses of the ALSPAC cohort of 12 944 women in England
Int J Epidemiol
Magnetic resonance imaging pelvimetry and the prediction of labor dystocia
Obstet Gynecol
Pelvimetry for fetal cephalic presentations at term
Cochrane Database Syst Rev
Cited by (71)
The sonopartogram
2023, American Journal of Obstetrics and GynecologyThe sonographic measurement of the ratio between the fetal head circumference and the obstetrical conjugate is accurate in predicting the risk of labor arrest: results from a multicenter prospective study
2022, American Journal of Obstetrics and Gynecology MFMPrediction of the mode of delivery using artificial intelligence algorithms
2022, Computer Methods and Programs in BiomedicinePrediction of unplanned cesarean section using measurable maternal and fetal characteristics, Ethiopia, a retrospective cohort study
2024, BMC Pregnancy and Childbirth
The authors report no conflict of interest.
This research was funded by the Health Research Board of Ireland.
Cite this article as: Burke N, Burke G, Breathnach F, et al. Prediction of cesarean delivery in the term nulliparous woman: results from the prospective, multi-center Genesis study. Am J Obstet Gynecol 2017;216:598.e1-11.