Risk factors of primary cesarean delivery after trial of labor

Risk factors of primary cesarean delivery after trial of labor
ปัจจัยเสี่ยงของการผ่าท้องคลอดครั้งแรกหลังจากพยายามดำเนินการคลอดทางช่องคลอด

Thanapan Choobun, D. of Obstetrics and Gynecology, F. of Medicine, PSU.
Hatern Tintara, Assoc. Prof., D. of Obstetrics and Gynecology, F. of Medicine, PSU.

Grant : Faculty of Medicine, PSU.
Published : Songkla Med J 2000, 18(1) : 23-29
Key words : cesarean section, cesarean delivery

Objective : To determine risk factors influencing the decision to perform primary cesarean section (C/S) after vaginal delivery trial.

Study Design : Cross-sectional study.

Setting : Labor Room, Songklanagarind Hospital.

Subjects : All viable singleton pregnant women without congenital anomalies who underwent child delivery at Songklanagarind Hospital during Jan 1, 1996 - Aug 18, 1996.

Results : There were 1,037 vaginal deliveries and 179 C/S after vaginal delivery trial. The primary C/S rate in pregnant women above 28 years old was 19.3% compared to 10.7% in pregnant women under 28 years old (p<0.001). Primigravid women had a higher C/S rate compared to multi-gravid women (24.6% vs. 4.9%, p<0.001). Pregnant women who had cervical dilatation < 3 cm on admission had a higher C/S rate (23.0% vs. 5.3%, p<0.001). Abnormal labor progression was found to increase the C/S rate (85.1% vs. 9.3%, p<0.001). The C/S rate found in the time during 4.01 p.m.-0.00 a.m. and at other times were 24.4% and 10.1% respectively (p<0.001). In addition, mean birth weight of C/S group were higher than those delivered by vaginal route (3,266ฑ521 gm vs. 3,083ฑ426 gm, p<0.001). The odds ratio of C/S after vaginal delivery trial for abnormal labor progression was 45.87, (95% CI=23.14-90.90, p=0.000), for primigravid 7.48 (95% CI=4.41-12.70, p=0.000), for pregnant women aged above 28 years 3.83 (95% CI = 2.46-5.98, p=0.000), for cervical dilatation < 3 cm at admission 2.94 (95% CI=1.76-4.91, p=0.000), for labor during 4.01 p.m.-0.00 a.m. 2.00 (95% CI=1.31-3.05, p=0.001) and for birth weight more than 3,100 gm 1.83 (95% CI=1.19-2.80, p=0.006).

Conclusion : Risk factors influencing the decision to perform primary C/S after vaginal deli-very trial were abnormal labor progression, above 28 years of age, cervical dilatation less than 3 cm on admission, evening shift and birth weight more than 3,100 gm.

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