Intrapartum cesarean section: clinical characteristics, demographics, medical history, and course of pregnancy and labor

BACKGROUND: Cesarean delivery rates continue to rise, as does the percentage of intrapartum cesarean section, highlighting the relevance of research on the subject. Risk factors for emergency cesarean delivery include a burdened medical or obstetric and gynecological history (hypertension, diabetes mellitus, etc.) as well as pregnancy complications (pregnancy-induced hypertension, pre-eclampsia, gestational diabetes, fetal malpresentation, etc.). Analyzing these factors can help to identify risk groups, improve labor management, and reduce maternal and neonatal morbidity.

AIM: The work aimed to assess the impact of maternal history and course of labor on the mode of delivery and neonatal outcomes.

METHODS: The study included 391 patients. Patients were divided into the main group (intrapartum cesarean section) and the control group (cesarean section before the onset of labor). The main group was divided into three subgroups. Subgroup 1 (latent phase) included 48 patients who had a cesarean section at a cervical dilatation of 1–4 cm; subgroup 2 (active phase) included 43 patients who had a cesarean section at a cervical dilatation of 5–9 cm; and subgroup 3 included 195 patients who had a cesarean section at full dilatation. The control group (n = 105) included patients who had a cesarean section before the onset of labor. Each patient's medical records on the course of pregnancy and labor and mode of delivery were analyzed.

RESULTS: Overweight and obesity were most common in the control group; moreover, this group had the shortest gestational age at the time of cesarean section. Chronic hypertension was more common in the active phase subgroup than in the full dilatation subgroup (р < 0.05). Oxytocin induction was less common in the full dilatation subgroup (p < 0.05). In the latent phase subgroup, primary uterine inertia was the most common indication for cesarean section (p < 0.05), whereas secondary inertia was more common in the active phase and full dilatation subgroups (р < 0.05). The full dilatation subgroup had the highest intraoperative blood loss (~ 600 mL; p < 0.05). The highest birth weight was reported in the full dilatation subgroup (3632 g; p < 0.05), while the highest 1-minute Apgar scores were observed in the latent phase subgroup (8 points; p < 0.05).

CONCLUSION: The maternal history and course of labor have a direct impact on the mode of delivery and neonatal outcomes. The findings highlight the relevance of assessing maternal history and course of labor in real-world practice.