Predicting Cesarean Delivery After Induction of Labor Among Nulliparous Women at Term

Mary Catherine Tolcher, Michael R. Holbert, Amy L. Weaver, Michaela E. McGree, Janet E Olson, Sherif A. El-Nashar, Abimbola O. Famuyide, Brian C. Brost

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

OBJECTIVE:: To identify independent risk factors for cesarean delivery after induction of labor and to develop a nomogram for predicting cesarean delivery among nulliparous women undergoing induction of labor at term. METHODS:: This is a retrospective cohort study including nulliparous women with singleton, term (37 0/7 weeks of gestation or greater), cephalic pregnancies undergoing induction of labor from July 1, 2006, through May 31, 2012, at a tertiary care academic center. Inductions were identified using International Classification of Diseases, 9th Revision codes. Demographic, delivery, and outcome data were abstracted manually from the medical record. Women with a contraindication to vaginal delivery (malpresentation, abnormal placentation, prior myomectomy) were excluded. Independent risk factors for cesarean delivery were identified using logistic regression. RESULTS:: During the study period, there were 785 nulliparous inductions that met study criteria; 231 (29.4%) underwent cesarean delivery. Independent risk factors associated with an increased risk of cesarean delivery included older maternal age, shorter maternal height, greater body mass index, greater weight gain during pregnancy, older gestational age, hypertension, diabetes mellitus, and initial cervical dilation less than 3 cm. A nomogram was constructed based on the final model with a bias-corrected c-index of 0.709 (95% confidence interval 0.671–0.750). CONCLUSION:: We identified independent risk factors that can be used to predict cesarean delivery among nulliparous women undergoing induction of labor at term. If validated in other populations, the nomogram could be useful for individualized counseling of women with a combination of identifiable antepartum risk factors. LEVEL OF EVIDENCE:: II

Original languageEnglish (US)
JournalObstetrics and Gynecology
DOIs
StateAccepted/In press - Oct 5 2015

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Induced Labor
Nomograms
Pregnancy
Uterine Myomectomy
Placentation
Pregnancy Induced Hypertension
Maternal Age
International Classification of Diseases
Tertiary Care Centers
Gestational Age
Weight Gain
Medical Records
Counseling
Dilatation
Diabetes Mellitus
Body Mass Index
Cohort Studies
Retrospective Studies
Logistic Models
Head

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Tolcher, M. C., Holbert, M. R., Weaver, A. L., McGree, M. E., Olson, J. E., El-Nashar, S. A., ... Brost, B. C. (Accepted/In press). Predicting Cesarean Delivery After Induction of Labor Among Nulliparous Women at Term. Obstetrics and Gynecology. https://doi.org/10.1097/AOG.0000000000001083

Predicting Cesarean Delivery After Induction of Labor Among Nulliparous Women at Term. / Tolcher, Mary Catherine; Holbert, Michael R.; Weaver, Amy L.; McGree, Michaela E.; Olson, Janet E; El-Nashar, Sherif A.; Famuyide, Abimbola O.; Brost, Brian C.

In: Obstetrics and Gynecology, 05.10.2015.

Research output: Contribution to journalArticle

Tolcher, Mary Catherine ; Holbert, Michael R. ; Weaver, Amy L. ; McGree, Michaela E. ; Olson, Janet E ; El-Nashar, Sherif A. ; Famuyide, Abimbola O. ; Brost, Brian C. / Predicting Cesarean Delivery After Induction of Labor Among Nulliparous Women at Term. In: Obstetrics and Gynecology. 2015.
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AU - Olson, Janet E

AU - El-Nashar, Sherif A.

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N2 - OBJECTIVE:: To identify independent risk factors for cesarean delivery after induction of labor and to develop a nomogram for predicting cesarean delivery among nulliparous women undergoing induction of labor at term. METHODS:: This is a retrospective cohort study including nulliparous women with singleton, term (37 0/7 weeks of gestation or greater), cephalic pregnancies undergoing induction of labor from July 1, 2006, through May 31, 2012, at a tertiary care academic center. Inductions were identified using International Classification of Diseases, 9th Revision codes. Demographic, delivery, and outcome data were abstracted manually from the medical record. Women with a contraindication to vaginal delivery (malpresentation, abnormal placentation, prior myomectomy) were excluded. Independent risk factors for cesarean delivery were identified using logistic regression. RESULTS:: During the study period, there were 785 nulliparous inductions that met study criteria; 231 (29.4%) underwent cesarean delivery. Independent risk factors associated with an increased risk of cesarean delivery included older maternal age, shorter maternal height, greater body mass index, greater weight gain during pregnancy, older gestational age, hypertension, diabetes mellitus, and initial cervical dilation less than 3 cm. A nomogram was constructed based on the final model with a bias-corrected c-index of 0.709 (95% confidence interval 0.671–0.750). CONCLUSION:: We identified independent risk factors that can be used to predict cesarean delivery among nulliparous women undergoing induction of labor at term. If validated in other populations, the nomogram could be useful for individualized counseling of women with a combination of identifiable antepartum risk factors. LEVEL OF EVIDENCE:: II

AB - OBJECTIVE:: To identify independent risk factors for cesarean delivery after induction of labor and to develop a nomogram for predicting cesarean delivery among nulliparous women undergoing induction of labor at term. METHODS:: This is a retrospective cohort study including nulliparous women with singleton, term (37 0/7 weeks of gestation or greater), cephalic pregnancies undergoing induction of labor from July 1, 2006, through May 31, 2012, at a tertiary care academic center. Inductions were identified using International Classification of Diseases, 9th Revision codes. Demographic, delivery, and outcome data were abstracted manually from the medical record. Women with a contraindication to vaginal delivery (malpresentation, abnormal placentation, prior myomectomy) were excluded. Independent risk factors for cesarean delivery were identified using logistic regression. RESULTS:: During the study period, there were 785 nulliparous inductions that met study criteria; 231 (29.4%) underwent cesarean delivery. Independent risk factors associated with an increased risk of cesarean delivery included older maternal age, shorter maternal height, greater body mass index, greater weight gain during pregnancy, older gestational age, hypertension, diabetes mellitus, and initial cervical dilation less than 3 cm. A nomogram was constructed based on the final model with a bias-corrected c-index of 0.709 (95% confidence interval 0.671–0.750). CONCLUSION:: We identified independent risk factors that can be used to predict cesarean delivery among nulliparous women undergoing induction of labor at term. If validated in other populations, the nomogram could be useful for individualized counseling of women with a combination of identifiable antepartum risk factors. LEVEL OF EVIDENCE:: II

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