Original Articles

Influencing Factor Analysis and Prediction Model of Emergency Caesarean Delivery for Advanced-Age Nulliparous Women at the Time of Hospitalization

Abstract

Objective: In Japan, the number of nulliparous pregnant women of advanced age, defined as 35 years or older, has increased, and the age range has lengthened towards older age with the increased use of infertility treatments. Given this trend, adverse labour outcomes, such as emergency caesarean delivery (ECD), are expected to increase. Therefore, by focusing mainly on maternal age and infertility treatment history, we aimed to establish a new prediction model for the likelihood of ECD after identifying the influencing factors related to maternal and labour-related characteristics.
Materials and methods: The medical records of 1,521 pregnant women who were nulliparous between 2017/4/1 and 2024/3/31 at our hospital were retrospectively reviewed. First, for the 675 women who were aged 30 years old or more, we calculated the rates of ECD in 8 groups classified according to maternal age, infertility treatment, and other variables. Next, we performed multivariate logistic regression analysis to assess the effect of each representative factor and established a prediction model based on the number of factors that were significant in the multivariate analysis.
Results: Simple comparisons classified by maternal age revealed a constant increase in the rate of ECD with increasing maternal age, and multivariate analysis revealed 7 significant factors, namely, advanced maternal age, history of using assisted reproductive techniques (ART), small height, high Body mass index (BMI), low Bishop score, late-term delivery, and large infant. In the prediction model constructed with these 7 factors, the rate of ECD increased as the number of these factors increased.
Conclusion: The negative impact of advanced maternal age, namely, 40 years or older, and ART history, on labour outcome is clear. A new prediction model has the potential to identify patients with an extremely high probability of needing an ECD. These results may indicate that the management of the labour process will become more difficult in the future.

1. Wennberg AL, Opdahl S, Bergh C, Aaris Henningsen AK, Gissler M, Romundstad LB, et al. Effect of maternal age on maternal and neonatal outcomes after assisted reproductive technology. Fertil Steril. 2016;106(5):1142-9 e14.
2. Finer LB, Philbin JM. Trends in ages at key reproductive transitions in the United States, 1951-2010. Womens Health Issues. 2014;24(3):e271-9.
3. Breart G, Barros H, Wagener Y, Prati S. Characteristics of the childbearing population in Europe. Eur J Obstet Gynecol Reprod Biol. 2003;111 Suppl 1:S45-52.
4. Ogawa K, Urayama KY, Tanigaki S, Sago H, Sato S, Saito S, et al. Association between very advanced maternal age and adverse pregnancy outcomes: a cross sectional Japanese study. BMC Pregnancy Childbirth. 2017;17(1):349.
5. Hibino Y, Shimazono Y. Impact of egg donation deliveries from domestic and overseas sources on maternal care: a questionnaire survey of Japanese perinatal physicians. Environ Health Prev Med. 2014;19(4):271-8.
6. Kim EH, Lee J, Lee SA, Jung YW. Impact of Maternal Age on Singleton Pregnancy Outcomes in Primiparous Women in South Korea. J Clin Med. 2022;11(4).
7. Walker KF, Bugg GJ, Macpherson M, McCormick C, Grace N, Wildsmith C, et al. Randomized Trial of Labor Induction in Women 35 Years of Age or Older. N Engl J Med. 2016;374(9):813-22.
8. Ankarcrona V, Altman D, Wikstrom AK, Jacobsson B, Brismar Wendel S. Delivery outcome after trial of labor in nulliparous women 40 years or older-A nationwide population-based study. Acta Obstet Gynecol Scand. 2019;98(9):1195-203.
9. Wang JG, Sun JL, Shen J. Factors affecting failed trial of labor and countermeasures: A retrospective analysis. World J Clin Cases. 2020;8(16):3483-92.
10. Isono W, Wada-Hiraike O, Akino N, Terao H, Harada M, Hirata T, et al. The efficacy of non-assisted reproductive technology treatment might be limited in infertile patients with advanced endometriosis in their 30s. J Obstet Gynaecol Res. 2019;45(2):368-75.
11. Kenny LC, Lavender T, McNamee R, O'Neill SM, Mills T, Khashan AS. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PLoS One. 2013;8(2):e56583.
12. Isono W, Nagamatsu T, Uemura Y, Fujii T, Hyodo H, Yamashita T, et al. Prediction model for the incidence of emergent cesarean section during induction of labor specialized in nulliparous low-risk women. J Obstet Gynaecol Res. 2011;37(12):1784-91.
13. Iliescu DG, Belciug S, Ivanescu RC, Dragusin RC, Cara ML, Laurentiu D. Prediction of labor outcome pilot study: evaluation of primiparous women at term. Am J Obstet Gynecol MFM. 2022;4(6):100711.
14. Bouzaglou A, Aubenas I, Abbou H, Rouanet S, Carbonnel M, Pirtea P, Ayoubi JMB. Pregnancy at 40 years Old and Above: Obstetrical, Fetal, and Neonatal Outcomes. Is Age an Independent Risk Factor for Those Complications? Front Med (Lausanne). 2020;7:208.
15. Tun MH, Chari R, Kaul P, Mamede FV, Paulden M, Lefebvre DL, et al. Prediction of odds for emergency cesarean section: A secondary analysis of the CHILD term birth cohort study. PLoS One. 2022;17(10):e0268229.
16. Verma G, L., Spalding J, J., Wilkinson M, D., Hofmeyr G, J., Vannevel V, O'Mahony F. Instruments for assisted vaginal birth. Cochrane Database Syst Rev. 2021;9(9):CD005455.
17. Majoko F, Gardener G. Trial of instrumental delivery in theatre versus immediate caesarean section for anticipated difficult assisted births. Cochrane Database Syst Rev. 2012;10(10):CD005545.
18. Bishop EH. Pelvic scoring for elective induction. Obstet Gynecol. 1964;24:266-8.
19. Vrouenraets F, Roumen F, Dehing C, Akker E, Aarts M, Scheve E. Bishop score and risk of cesarean delivery after induction of labor in nulliparous women. Obstet Gynecol. 2005;105(4):690-7.
20. Sinha P, Gupta M, Meena S. Comparing Transvaginal Ultrasound Measurements of Cervical Length to Bishop Score in Predicting Cesarean Section Following Induction of Labor: A Prospective Observational Study. Cureus. 2024;16(2):e54335.
21. Yo Y, Kotani Y, Shiro R, Yamamoto K, Fujishima R, Takaya H, et al. Relationship between cervical elastography and spontaneous onset of labor. Sci Rep. 2020;10(1):19685.
22. Eltayeb RA, Khalifa AA. Impact of Maternal Body Mass Index on Maternal and Neonatal Outcomes among Sudanese Women. Cureus. 2021;13(9):e18365.
23. Meyer R, Yinon Y, Levin G. Vaginal delivery rate by near delivery sonographic weight estimation and maternal stature among nulliparous women. Birth. 2023;50(3):557-64.
24. Isono W, Wada-Hiraike O, Shirane A, Fujimoto A, Osuga Y, Yano T, et al. Alternative strategies to in vitro fertilization/intracytoplasmic sperm injection treatment for aged infertile women. Reprod Med Biol. 2012;11(1):69-72.
25. Bjorklund J, Wiberg-Itzel E, Wallstrom T. Is there an increased risk of cesarean section in obese women after induction of labor? A retrospective cohort study. PLoS One. 2022;17(2):e0263685.
26. Shinohara S, Amemiya A, Takizawa M. Fetal Biparietal Diameter as a Potential Risk Factor for Emergency Cesarean Section due to Labor Arrest.
Tohoku J Exp Med. 2020;250(3):161-6.
27. Martis R, Crowther CA, Shepherd E, Alsweiler J, Downie MR, Brown J. Treatments for women with gestational diabetes mellitus: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2018;8(8):CD12327.
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IssueVol 18, No 4 (December 2024) QRcode
SectionOriginal Articles
DOI https://doi.org/10.18502/jfrh.v18i4.17410
Keywords
Nulliparous Pregnant Woman Advanced Maternal Age Assisted Reproductive Technology Emergency Caesarean Delivery Prediction Model
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How to Cite
1.
Arakaki R, Isono W, Fukuda H, Tanaka J, Minamino A, Hayashi S. Influencing Factor Analysis and Prediction Model of Emergency Caesarean Delivery for Advanced-Age Nulliparous Women at the Time of Hospitalization. J Family Reprod Health. 2024;18(4):217-225.