Emergency caesarean section in low risk nulliparous women

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Public Health

Background:

• Rising caesarean section (CS) rates, especially emergency caesarean sections (ECS) in nulliparous women, warrant investigation.
• Previous CS can impact future pregnancies and deliveries, highlighting the need to understand ECS indications and risk factors.

Purpose of the Study:

• To determine the prevalence and indications of ECS in a low-risk nulliparous cohort.
• To identify maternal and fetal risk factors associated with ECS, specifically for failure-to-progress (FTP) and suspected fetal distress (SFD).

Main Methods:

• Retrospective analysis of 2,748 low-risk nulliparous women.
• Multivariate logistic regression to assess associations between risk factors and ECS indications (FTP, SFD).

Main Results:

• 8.7% of women underwent ECS.
• Failure-to-progress (FTP) was the primary indication (68.3%), followed by suspected fetal distress (SFD) (30.4%).
• Smoking during pregnancy and BMI ≥ 30 increased SFD-related ECS risk. High birth weight and smoking cessation increased FTP-related ECS risk.

Conclusions:

• Specific maternal and fetal factors are significantly associated with ECS in low-risk nulliparas.
• Understanding these risk factors can inform strategies to potentially reduce ECS rates and improve maternal-fetal outcomes.