Evaluation of risk factors for intrapartum caesarean section in low risk multiparous women with prior vaginal deliveries

Authors

  • Shradhdha M. Vala Department of Obstetrics and Gynecology, SSG Hospital and Baroda Medical College, Baroda, Gujarat, India
  • Purvi K.Patel

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20231210

Keywords:

Caesarean section (CS), Multipara, Previous vaginal delivery

Abstract

Background: In 2015, WHO proposed the use of the Robson classification as a global standard for assessing, monitoring and comparing caesarean section rates both within and between healthcare facilities. Robson’s group 3 and 4 consist of multiparous women with term singleton pregnancies who have previously delivered vaginally and attempts to audit the caesarean sections in these 2 groups may be helpful to reduce primary caesarean sections in multiparous women.

Methods: The eligible subjects (belonging to Robson group 3 and 4) were recruited from the labor room of the Obstetrics and Gynecology department of SSG hospital, Baroda. Those who delivered by caesarean section during the study period were enrolled in the study as cases. Those who delivered vaginally immediately following the case formed the controls. Relevant demographic characteristics, parity, interval time between prior birth, history of macrosomic birth, cervical dilatation at the admission to the hospital, obstetric and neonatal outcomes were obtained and analyzed..

Results: On performing multivariate regression, age, birth weight of previous child, time since last delivery, cervical dilatation were found to be significant independent risk factors for LSCS after adjusting for confounding factors. The most common indication for caesarean section was fetal distress with meconium stained liquor.

Conclusions: In low risk multiparous women with previous vaginal delivery, Maternal age, birth weight of previous child, time since last delivery and cervical dilatation were significant independent risk factors of LSCS. Gestational age, parity, BMI and labor induction were not found to increase the risk of caesarean delivery.

References

WHO. Appropriate technology for birth. Lancet. 1985;2:436-7.

Betran AP, Torloni MR, Zhang JJ, Gülmezoglu AMWHO Working Group on Caesarean Section. WHO Statement on Caesarean Section Rates. BJOG. 2016;123(05):667-70.

Betran AP, Ye J, Moller A. Trends and projections of caesarean section rates: global and regional estimates. BMJ Global Health. 2021;6:e005671.

Torloni MR, Betran AP, Souza JP, Widmer M, Allen T, et al. Classifications for caesarean section: a systematic review. PLoS ONE. 2011;6:e14566.

Robson M, Hartigan L, Murphy M. Methods of achieving and maintaining an appropriate caesarean section rate. Best Pract Res Clin Obstet Gynaecol. 2013;27:297-308.

WHO. Robson classification-Implementation manual. 2015

Desai E, Leuva H, Leuva B, Kanani M. A study of primary caesarean section in multipara. Int J Reprod Contracept Obstet Gynecol. 2013;2:320-4.

Jacob S, Bhargava H. Primary caesarean section in multipara. J Obstet Gynaecol India. 1972;22(6):642- 50.

Ford J, Grewal J, Mikolajczyk R. Primary caesarean delivery among parous women in the United States, 1990-2003. Obstet Gynecol. 2008;112(6):1235-41.

Devi GR, Patnaik US, Suseela AVN. Institutional study of primary caesarean section among multigravida. Intl J Med Health Res. 2019;5(8):111-4.

Buyuk GN, Celik HK, Kaplan ZAO, Kisa B, Ozel S, Ustun B. Risk factors for intrapartum caesarean section delivery in low-risk multiparous women following at least a prior vaginal birth (Robson Classification 3 and 4). Rev Bras Ginecol Obstet. 2021;43(6):20-1.

Levine LD, Hirshberg A, Srinivas S. Term induction of labor and risk of caesarean delivery by parity. J Matern Fetal Neonatal Med. 2014;27(12):1232-6.

Thorsell M, Lyrenäs S, Andolf E, Kaijser M. Induction of labor and the risk for emergency caesarean section in nulliparous and multiparous women. Acta Obstet Gynecol Scand. 2011;90(10):1094-9.

Rossi RM, Requarth E, Warshak CR, Dufendach KR, Hall ES, DeFranco EA. Risk calculator to predict caesarean delivery among women undergoing induction of labor. Obstet Gynecol. 2020;135(3):559-68.

Derbent AU, Karabulut A, Yıldırım M, Simavlı SA, Turhan NÖ. Evaluation of risk factors in caesarean delivery among multiparous women with a history of vaginal delivery. J Turk Ger Gynecol Assoc. 2012;13(1):15-20.

Holmes P, Oppenheimer LW, Wen SW. The relationship between cervical dilatation at initial presentation in labour and subsequent intervention. BJOG. 2001;108(11):1120–4.

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):77-9.

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):188-94.

Harrison MS, Garces AL, Goudar SS, Saleem S, Moore JL, Esamai F, et al. Caesarean birth in the Global Network. 2021;4:76-9.

Downloads

Published

2023-04-28

Issue

Section

Original Research Articles