Can C-Section risk be Predicted in Nulliparous Women?
This study by Burke et al. (AJOG, 2017) aimed to determine if it is possible to use maternal and fetal, clinical, anthropomorphic, and ultrasound information to create a tool to predict the risk of C-section before onset of labor in nulliparous women.
Blinded prospective multicenter national study
2,336 nulliparous women were recruited for this study as part of the Genesis trial. Entrance criteria included vertex presentation between 39+0 and 40+6 weeks’ gestation. Study subjects underwent a detailed clinical evaluation and prenatal ultrasound examination. All hypothetical risk factors were assessed together as a composite score. 491 (21%) of the women had an unplanned C-section. It was determined that advancing maternal age, shorter maternal height, increasing BMI, larger fetal abdominal circumference, and larger fetal head circumference were the best combined predictors to be used in the nomogram to predict C-section risk. The authors suggest that this approach to risk calculation can be used to stratify women into a low risk/reassurance group or those who should avoid trial of labor.
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