What is it about?
Our study aimed to identify pregnant women who are at increased risk of emergency caesarean delivery. We found that in addition to the mother’s age, height, body mass index and weight gain, it is helpful to know how much the baby weighs at 36 weeks of gestation according to an ultrasound measurement. Overgrowth of the baby increases the risk. The babies of women who had a higher risk of emergency caesarean delivery were also more likely to be ill at birth.
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Why is it important?
The information from our prediction model has immediate clinical application, in addition to informing future clinical trials. Some women choose to deliver at home or in units which lack the facilities to perform emergency caesarean sections, such as low risk birthing units. Transfer during labour is known to be a high risk situation. The predicted risk of emergency caesarean delivery may help inform decisions around the place of birth. This is of particular importance for fist-time mothers as there is high quality evidence that planned home delivery is associated with a higher rate of complications in these women.
Perspectives
Risk prediction is a challenging task which is worthwhile when information on the risk can have an impact on the course of action with a potential to improve outcomes. Among a large group of first-time mothers, we predicted that the risk of emergency caesarean delivery is increased when the mother is older, shorter or heavier than average, if she puts on a lot of weight during pregnancy or if her baby is large at 36 weeks of gestation. Importantly, we were able to validate our prediction model in a very large external group of first-time mothers. The model identified about 6% of women at high risk who had about 50/50 chance of undergoing emergency caesarean delivery, whereas the risk in the remaining 94% of women was on average much lower. The high-risk women had considerable blood loss following delivery more often and their babies’ outcomes were poorer. We have developed a risk calculator which gives an individual risk estimate based on an ultrasound scan at 34-38 weeks of gestation and maternal characteristics. This tool can inform decisions about the place of birth and delivery a few weeks before the due date.
Dr Ulla Sovio
University of Cambridge
Read the Original
This page is a summary of: Blinded ultrasound fetal biometry at 36 weeks and risk of emergency Cesarean delivery in a prospective cohort study of low‐risk nulliparous women, Ultrasound in Obstetrics and Gynecology, June 2018, Wiley,
DOI: 10.1002/uog.17513.
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