Using the Probability of Cesarean from a Validated Cesarean Prediction Calculator to Predict Labor Length and Morbidity

Rebecca F. Hamm; Katheryne L. Downes; Sindhu K. Srinivas; Lisa D. Levine

doi:10.1055/s-0038-1675625

American Journal of Perinatology, Table of Contents

Am J Perinatol 2019; 36(06): 561-566
DOI: 10.1055/s-0038-1675625

SMFM Fellowship Series Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Using the Probability of Cesarean from a Validated Cesarean Prediction Calculator to Predict Labor Length and Morbidity

Authors

Rebecca F. Hamm

¹Maternal and Child Health Research Center, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Katheryne L. Downes

¹Maternal and Child Health Research Center, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Sindhu K. Srinivas

¹Maternal and Child Health Research Center, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Lisa D. Levine

¹Maternal and Child Health Research Center, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania

Abstract

Objective To determine if increasing predicted risk of cesarean was associated with longer labor length and increased morbidity among women undergoing induction with an unfavorable cervix.

Study Design Using a publically available database, we evaluated whether a previously validated prediction model for cesarean delivery after induction was associated with labor length, maternal morbidity (third-/fourth-degree lacerations, endometritis, blood transfusion, wound infection, venous thromboembolism, hysterectomy, intensive care unit admission, and death), and neonatal morbidity (blood transfusion, encephalopathy, intraventricular hemorrhage, severe respiratory distress syndrome, necrotizing enterocolitis, and sepsis). Full-term (≥37 weeks) singleton gestations with intact membranes and an unfavorable cervix (Bishop score ≤6 and dilation ≤2 cm) undergoing induction of labor were included.

Results A total of 8,466 women met the inclusion criteria. Each category increase in cesarean probability (<20, 20–39.9, 40–59.9, ≥60%) was associated with an increase in labor length (9.6, 10.8, 11.7, and 11.9 hours, respectively; p < 0.001). With increasing predicted probability of cesarean there, was also a significant increase in maternal morbidity with each category (2.6, 4.7, 5.1, 6.1%; p = 0.001) and increase in neonatal morbidity (0.9, 1.5, 2, 2.2%; p = 0.002).

Conclusion Using a validated prediction model for cesarean delivery among women induced with an unfavorable cervix, increasing predicted probability of cesarean is associated with longer labor length and increased maternal and neonatal morbidity.

Keywords

calculator - cesarean section - induction of labor - labor length - maternal morbidity - neonatal morbidity - unfavorable cervix

Full Text

References

References
1 Center for Disease Control and Prevention. Recent declines in induction of labor. Available at: http://www.cdc.gov/nchs/data/databriefs/db155.htm . Accessed March 1, 2016
2 Rouse DJ, Weiner SJ, Bloom SL. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU). Failed labor induction: toward an objective diagnosis. Obstet Gynecol 2011; 117 (2 Pt 1): 267-272
3 Vahratian A, Zhang J, Troendle JF, Sciscione AC, Hoffman MK. Labor progression and risk of cesarean delivery in electively induced nulliparas. Obstet Gynecol 2005; 105 (04) 698-704
4 Grobman WA. Predictors of induction success. Semin Perinatol 2012; 36 (05) 344-347
5 Tolcher MC, Holbert MR, Weaver AL. , et al. Predicting cesarean delivery after induction of labor among nulliparous women at term. Obstet Gynecol 2015; 126 (05) 1059-1068
6 Levine LD, Downes KL, Parry S, Elovitz MA, Sammel MD, Srinivas SK. A validated calculator to estimate risk of cesarean after an induction of labor with an unfavorable cervix. Am J Obstet Gynecol 2018; 218 (02) 254.e1-254.e7
7 Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol 2012; 120 (05) 1181-1193
8 Cheng YW, Shaffer BL, Bryant AS, Caughey AB. Length of the first stage of labor and associated perinatal outcomes in nulliparous women. Obstet Gynecol 2010; 116 (05) 1127-1135
9 Maghoma J, Buchmann EJ. Maternal and fetal risks associated with prolonged latent phase of labour. J Obstet Gynaecol 2002; 22 (01) 16-19
10 Rouse DJ, McCullough C, Wren AL, Owen J, Hauth JC. Active-phase labor arrest: a randomized trial of chorioamnion management. Obstet Gynecol 1994; 83 (06) 937-940
11 Lisonkova S, Muraca GM, Potts J. , et al. Association between prepregnancy body mass index and severe maternal morbidity. JAMA 2017; 318 (18) 1777-1786
12 Grobman WA, Bailit JL, Rice MM. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Frequency of and factors associated with severe maternal morbidity. Obstet Gynecol 2014; 123 (04) 804-810