Related Experiment Video
Updated: May 3, 2026
External Cephalic Version: Is it an Effective and Safe Procedure?
Published on: June 6, 2020
Indications for caesarean sections at ≥34 weeks among nulliparous women and differential composite maternal and
S P Chauhan1, H Beydoun, I A Hammad
1Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA.
Objective:
To compare composite maternal and neonatal morbidities (CMM, CNM) among nulliparous women with primary indications for caesarean section (CS) as acute clinical emergency (group I; ACE), non-reassuring fetal heart rate (group II) and arrest disorder (group III).
Design:
A multicentre prospective study.
Setting:
Nineteen academic centres in the USA, with deliveries in 1999-2002.
Population:
Nulliparous women (n = 9829) that had CS.
Methods:
Nulliparous women undergoing CS for three categories of indications were compared using logistic regression model, adjusted for five variables.
Main Outcome Measures:
CMM was defined as the presence of any of the following: intrapartum or postpartum transfusion, uterine rupture, hysterectomy, cystotomy, ureteral or bowel injury or death; CNM was defined as the presence of any of the following: umbilical arterial pH <7.00, neonatal seizure, cardiac, hepatic, renal dysfunction, hypoxic ischaemic encephalopathy or neonatal death.
Results:
The primary reasons for CS were ACE in 1% (group I, n = 114) non-reassuring FHR in 29% (group II; n = 2822) and failed induction/dystocia in the remaining 70% (group III; n = 6893). The overall risks of CMM and CNM were 2.5% (95% confidence intervals, CI, 2.2-2.8%) and 1.9% (95% CI 1.7-2.2), respectively. The risk of CMM was higher in group I than in group II (RR 4.1, 95% CI 3.1, 5.3), and group III (RR 3.2, 95% CI 2.7, 3.7). The risk of CNM was also higher in group I than in group II (RR 2.8, 95% CI 2.3, 3.4) and group III (RR 14.1, 95% CI 10.7, 18.7).
Conclusions:
Nulliparous women who have acute clinically emergent caesarean sections are at the highest risks of both composite maternal and neonatal morbidity and mortality.
