Journal
JOURNAL OF PERINATOLOGY
Volume 35, Issue 3, Pages 167-172Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/jp.2014.179
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Funding
- Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health [HHSN267200603425C]
- NICHD [K23 HD076010]
- NIH
- University of Illinois at Chicago (UIC) Center for Clinical and Translational Science (CCTS), from the National Center for Research Resources [UL1RR029879]
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OBJECTIVE: To determine risk factors for cesarean delivery in nulliparas at labor admission. STUDY DESIGN: Nulliparas with live-born, singleton gestations >= 37 weeks in spontaneous or induced labor were analyzed from the Consortium on Safe Labor database in a retrospective observational study. Classification and regression tree (CART) and multivariate logistic regression analysis determined risk factors for cesarean delivery. RESULT: Of the 66 539 nulliparas, 22% had a cesarean delivery. In the CART analysis, the first cervical dilation exam was the first branch followed by body mass index (BMI). Cesarean deliveries occurred in 45%, 25%, 14% and 10% of deliveries at < 1, 1 to 3,4 and >= 5 cm dilated, respectively. The BMI influence was most evident in the < 1 cm dilation category with 26% of BMI < 25 kg m(-2) and 66% of BMI >= 40 kg m(-2) having a cesarean delivery. The fewest cesarean deliveries (5%) occurred in those >= 5 cm and BMI < 25 kg m(-2). In the multivariate regression analysis, first cervical dilation exam < 1 cm (odds ratio (OR) 5.1, 95% confidence interval (Cl); 4.5 to 5.7; reference >= 5 cm) and BMI 40 kg m(-2) (OR 5.1, 95% Cl: 4.6 to 5.7; reference BMI < 25.0 kg m(-2)) had the highest odds for cesarean delivery. CONCLUSION: Cervical dilation on admission followed by BMI were the two most important risk factors for cesarean delivery identified in both CART and multivariate regression analysis.
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