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Risk Factors for Cesarean Delivery at Presentation of Nulliparous Patients in Labor

From the University of Colorado Health Sciences Center, Departments of Obstetrics and Gynecology, and Pharmaceutical Science, Denver, Colorado.

Address reprint requests to: Ronald S. Gibbs, MD, University of Colorado Health Sciences Center, Department of Obstetrics and Gynecology, 4200 East Ninth Avenue, Box B-198, Denver, CO 80262; E-mail: ronald.gibbs{at}uchsc.edu.

OBJECTIVE: To identify risk factors that place a term nulliparous patient in labor at risk for cesarean delivery.

METHODS: This was a case-control, chart review study of 325 nulliparous patients presenting in labor at term with singleton vertex fetuses with either cesarean (patients) or vaginal (controls) delivery. Dichotomous variables were analyzed by ² or Fisher exact tests; continuous variables were assessed by the Wilcoxon two-sample test. Multiple logistic regression was used to identify independent risk factors for cesarean delivery, and a model for predicting risk was built and evaluated.

RESULTS: In univariate analysis, 22 variables were significantly different between patients and controls. Of 11 that were known within 2 hours of admission, five (change in cervical dilatation, maternal weight, gestational age, fetal station at 2 hours, and preeclampsia) remained independently significant in a multiple logistic regression model for cesarean delivery. The multiple regression model could divide our study population into quintiles in which the lowest risk group had a 5% incidence and the highest risk group had an 88% incidence of cesarean delivery.

CONCLUSION: It may be possible to offer early cesarean delivery to patients at highest risk, reducing the potential morbidity of long labor or failed operative vaginal delivery followed by a later cesarean delivery.

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