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///2013 Abstract Details
2013 Abstract Details2019-08-02T16:57:45-05:00

Maternal Predictors of Emergency Cesarean Section

Abstract Number: S 11
Abstract Type: Original Research

Lacy Parker MD1 ; Jay Horrow MD, MS2; Norman Brest MD3; Andrew Day ..4; Dmitri Chamchad MD5; Veronica Mahon MD6

Introduction: US Cesarean section (C/S) deliveries increased 60% from 1996 to 2009, and one-third of births were by C/S in 2011 [1]. C/S carries increased morbidity, including wound complications, infection, hemorrhage, and thromboembolism [2,3]. Emergency C/S associates with ≈9-fold risk of maternal death compared to spontaneous vaginal delivery [4]. Obese nulliparous women and smokers more likely undergo emergency C/S [5]. What baseline characteristics can predict emergency C/S?

Methods: From 2007 to 2011, 2744 parturients underwent induction of labor at our institution. Among 18 demographic and process variables, stepwise multivariate logistic regression identified independent predictors of emergency C/S, with P<0.15 required to enter the model and P<0.05 to remain in it.

Results: These maternal factors predicted C/S: parity, hypertension, body weight, African-American race, intrapartum fever, age, forceps extraction attempt; and gestational age. Regression c-statistic= 0.828. The table displays odds ratios. Adding the process variable “late decelerations” as a predictor produced only 3 predictors: parity, body weight, and presence of late decelerations (c= 0.823).

Conclusions: Several maternal factors and gestational age predict emergency C/S, many of which correlate with late decelerations. Parity likely impacts results by representing the “proven” pelvis. Body weight achieved strong significance, but at only 0.6% per 10kg relative risk, particularly when compared to the 4.1% per year impact of maternal age. Smoking status, not determined, could not be tested in the current model.

References:

1. Hamilton BE. Births: Preliminary data for 2011. National vital statistics reports 2012; 61(5). Hyattsville: National Center for Health Statistics.

2. Declercq E. Obstet Gynecol, 2007;109:669

3. Burrows WR. Obstet Gynecol. 2004;103:907

4. Hall MH. Lancet 1999;354:776.

5. Haerskjold A. J Obstet Gynaecol 2012;32:543



SOAP 2013