Abstract
Purpose: To clarify the demographic and clinical risk factors for dystocia-related cesarean section (CS) among low-risk term nulliparous women.
Methods: The data of nulliparous women who delivered at the clinic between 2004 and 2021 were retrospectively collected. The inclusion criteria were delivery ≥37 weeks’ gestation, singleton pregnancy, and cephalic presentation. Women with fetal demise before onset of labor, non-vertex presentation, morbid obesity, and uncontrolled medical diseases were excluded. Women with CS by indications other than dystocia were also excluded. The following ten factors were compared between women who delivered vaginally and women with dystocia-related CS: maternal age, gestational age, maternal height, pre-pregnancy body weight (BW), pre-pregnancy body mass index (BMI), gestational weight gain (GWG), neonatal weight, neonatal head circumference (NHC), induction of labor (IOL), and pregnancy achieved by assisted reproductive technology (ART).
Results: Data of a total of 3,045 women were analyzed, of which 72 (2.4%) underwent dystocia-related CS. Simple regression analysis showed that nine factors except pre-pregnancy BW were significantly associated with CS. Multiple regression analysis showed that maternal age (OR1.202, 95% CI: 1.131-1.277, per 1 year increase, p<0.001), gestational age (OR 1.093, 95% CI: 1.042-1.145, per 1 day increase, p<0.001), maternal height (OR 0.847, 95% CI: 0.804-0.892, per 1 cm increase, p<0.001), BMI (OR 1.114, 95% CI: 1.011-1.226, per 1 kg/m2 increase, p=0.029), GWG (OR 1.086, 95% CI: 1.003-1.175, per 1 kg increase, p=0.041), neonatal weight (OR 1.195, 95% CI: 1.089-1.311, per 100 g increase, p<0.001), and IOL (OR 2.158, 95% CI 1.246-3.739, p=0.006) were significantly associated with CS, whereas NHC, and pregnancy achieved by ART were not. Conclusion: This study suggests the importance of an optimal pre-pregnancy BW and GWG, and the judicious use of IOL to avoid dystocia-related CS.
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