Top

Archives of Gynecology and Obstetrics

Published in:

01-04-2012 | Maternal-Fetal Medicine

Risk factors and perinatal outcome of pregnancies complicated with cephalopelvic disproportion: a population-based study

Authors: Oren Tsvieli, Ruslan Sergienko, Eyal Sheiner

Published in: Archives of Gynecology and Obstetrics | Issue 4/2012

Abstract

Objectives

To characterize risk factors and perinatal outcome following cephalopelvic disproportion (CPD).

Methods

A retrospective population-based study comparing all singleton deliveries of women with and without CPD, between 1988 and 2010, was conducted. A multiple logistic regression model was used to control for confounders.

Results

Out of 242,520 patients, 0.3% (n = 673) were diagnosed with CPD. Using a multivariable analysis, the following obstetric risk factors were significantly associated with CPD: fetal macrosomia (birth weight above 4 kg, OR = 3.3, 95% CI 2.7–4.1, P < 0.001), infertility treatment (OR = 2.6, 95% CI 1.8–3.8, P < 0.001), previous caesarean delivery (OR = 2.2, 95% CI 1.9–2.7, P < 0.001), maternal obesity (OR = 2.1, 95% 1.3–3.4, P < 0.001), and polyhydramnios (OR = 1.7, 95% CI 1.3–2.3, P < 0.001). Deliveries complicated by CPD resulted in Caesarean delivery in 99%, and were more likely to have laceration of the cervix (1.2 vs. 0.3%, P < 0.001), rupture of uterus (0.4 vs. 0.1%, P < 0.001), intrapartum mortality (0.6 vs. 0.1% in control, P < 0.001), and low 1-min Apgar scores (<7; 27.2 vs. 6.5%, P < 0.001).

Conclusions

In our population, independent risk factors for CPD include fetal macrosomia, infertility treatment, previous caesarean delivery, maternal obesity and polyhydramnion. These pregnancies had higher rates of adverse perinatal outcomes and accordingly high index of suspicion should be pursued when commencing trial of labor of such pregnancies.

Maharaj D (2010) Assessing cephalopelvic disproportion: back to the basics. Obstet Gynecol Surv 65(6):387–395PubMedCrossRef

Feinstein U, Sheiner E, Levy A, Hallak M, Mazor M (2002) Risk factors for arrest of descent during the second stage of labor. Int J Gynaecol Obstet 77(1):7–14PubMedCrossRef

Sheiner E, Levy A, Feinstein U, Hallak M, Mazor M (2002) Risk factors and outcome of failure to progress during the first stage of labor: a population-based study. Acta Obstet Gynecol Scand 81(3):222–226PubMed

Sheiner E, Levy A, Feinstein U, Hershkovitz R, Hallak M, Mazor M (2002) Obstetric risk factors for failure to progress in the first versus the second stage of labor. J Matern Fetal Neonatal Med 11(6):409–413PubMedCrossRef

Khunpradit S, Patumanond J, Tawichasri C (2005) Risk indicators for cesarean section due to cephalopelvic disproportion in Lamphun hospital. J Med Assoc Thai 88(Suppl 2):S63–S68PubMed

O’Hana HP, Levy A, Rozen A, Greemberg L, Shapira Y, Sheiner E (2008) The effect of epidural analgesia on labor progress and outcome in nulliparous women. J Matern Fetal Neonatal Med 21(8):517–521PubMedCrossRef

Burstein E, Levy A, Mazor M, Wiznitzer A, Sheiner E (2008) Pregnancy outcome among obese women: a prospective study. Am J Perinatol 25(9):561–566PubMedCrossRef

de Veciana M, Major CA, Morgan MA, Asrat T, Toohey JS, Lien JM et al (1995) Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. N Engl J Med 333(19):1237–1241PubMedCrossRef

Isaacs JD, Magann EF, Martin RW, Chauhan SP, Morrison JC (1994) Obstetric challenges of massive obesity complicating pregnancy. J Perinatol 14(1):10–14PubMed

10.

Levy A, Wiznitzer A, Holcberg G, Mazor M, Sheiner E (2010) Family history of diabetes mellitus as an independent risk factor for macrosomia and cesarean delivery. J Matern Fetal Neonatal Med 23(2):148–152PubMedCrossRef

11.

Tomic V, Bosnjak K, Petrov B, Dikic M, Knezevic D (2007) Macrosomic births at Mostar Clinical Hospital: a 2-year review. Bosn J Basic Med Sci 7(3):271–274PubMed

12.

Voigt M, Straube S, Zygmunt M, Krafczyk B, Schneider KT, Briese V (2008) Obesity and pregnancy—a risk profile. Z Geburtshilfe Neonatol 212(6):201–205PubMedCrossRef

13.

Liselele HB, Boulvain M, Tshibangu KC, Meuris S (2000) Maternal height and external pelvimetry to predict cephalopelvic disproportion in nulliparous African women: a cohort study. BJOG 107(8):947–952PubMedCrossRef

14.

Liselele HB, Tshibangu CK, Meuris S (2000) Association between external pelvimetry and vertex delivery complications in African women. Acta Obstet Gynecol Scand 79(8):673–678PubMed

15.

Barron LR, Hill RO, Linkletter AM (1964) X-Ray pelvimetry. Can Med Assoc J 91:1209–1212PubMed

16.

Campbell JA (1976) X-ray pelvimetry: useful procedure or medical nonsense. J Natl Med Assoc 68(6):514–520PubMed

17.

Poma PA (1982) Value of X-ray pelvimetry in primiparas. II: Influence on management of labor. J Natl Med Assoc 74(3):267–272PubMed

18.

ACOG Practice Bulletin Number 49 (2003) Dystocia and augmentation of labor. Obstet Gynecol 102(6):1445–1454

19.

Stevens-Simon C, McAnarney ER (1988) Adolescent maternal weight gain and low birth weight: a multifactorial model. Am J Clin Nutr 47(6):948–953PubMed

20.

Konje JC, Ladipo OA (2000) Nutrition and obstructed labor. Am J Clin Nutr 72(1 Suppl):291S–297SPubMed

21.

Sheiner E, Levy A, Katz M, Mazor M (2005) Short stature—an independent risk factor for Cesarean delivery. Eur J Obstet Gynecol Reprod Biol 120(2):175–178PubMedCrossRef

22.

Dujardin B, VanCutsem R, Lambrechts T (1996) The value of maternal height as a risk factor of dystocia: a meta-analysis. Trop Med Int Health 1(4):510–521PubMedCrossRef

23.

Awonuga AO, Merhi Z, Awonuga MT, Samuels TA, Waller J, Pring D (2007) Anthropometric measurements in the diagnosis of pelvic size: an analysis of maternal height and shoe size and computed tomography pelvimetric data. Arch Gynecol Obstet 276(5):523–528PubMedCrossRef

24.

Raichel L, Sheiner E (2005) Maternal obesity as a risk factor for complications in pregnancy, labor and pregnancy outcomes. Harefuah 144(2):107–111, 150

25.

Sheiner E, Levy A, Menes TS, Silverberg D, Katz M, Mazor M (2004) Maternal obesity as an independent risk factor for caesarean delivery. Paediatr Perinat Epidemiol 18(3):196–201PubMedCrossRef

26.

Abitbol MM, Taylor-Randall UB, Barton PT, Thompson E (1997) Effect of modern obstetrics on mothers from Third-World countries. J Matern Fetal Med 6(5):276–280PubMedCrossRef

27.

Mabille JP, Thery Y (1976) Multiple exostosis disease revealed by the occurence of dystocia (author’s transl). Ann Radiol (Paris) 19(4):463–467

28.

Wicklund CL, Pauli RM, Johnston D, Hecht JT (1995) Natural history study of hereditary multiple exostoses. Am J Med Genet 55(1):43–46PubMedCrossRef

29.

Stieber JR, Dormans JP (2005) Manifestations of hereditary multiple exostoses. J Am Acad Orthop Surg 13(2):110–120PubMed

30.

Jaluvka V, Bystricky Z (1966) What effects do pelvic fractures have on the course of pregnancy, menstruation and sexual life. Z Geburtshilfe Gynakol 166(1):45–59PubMed

31.

Magnin P, Schnepp H, Dargent D, Cherasse A (1969) Obstetric consequences of pelvic fractures. Gynecol Obstet (Paris) 68(3):237–258

32.

Speer DP, Peltier LF (1972) Pelvic fractures and pregnancy. J Trauma 12(6):474–480PubMedCrossRef

33.

Beck A, Schaller A (1975) Pelvic fractures from the obstetric viewpoint. Hefte Unfallheilkd (124):220–223

34.

Madsen LV, Jensen J, Christensen ST (1983) Parturition and pelvic fracture. Follow-up of 34 obstetric patients with a history of pelvic fracture. Acta Obstet Gynecol Scand 62(6):617–620PubMedCrossRef

35.

Copeland CE, Bosse MJ, McCarthy ML, MacKenzie EJ, Guzinski GM, Hash CS et al (1997) Effect of trauma and pelvic fracture on female genitourinary, sexual, and reproductive function. J Orthop Trauma 11(2):73–81PubMedCrossRef

36.

Pape HC, Pohlemann T, Gansslen A, Simon R, Koch C, Tscherne H (2000) Pelvic fractures in pregnant multiple trauma patients. J Orthop Trauma 14(4):238–244PubMedCrossRef

37.

Leggon RE, Wood GC, Indeck MC (2002) Pelvic fractures in pregnancy: factors influencing maternal and fetal outcomes. J Trauma 53(4):796–804PubMedCrossRef

38.

Loegters T, Briem D, Gatzka C, Linhart W, Begemann PG, Rueger JM et al (2005) Treatment of unstable fractures of the pelvic ring in pregnancy. Arch Orthop Trauma Surg 125(3):204–208PubMedCrossRef

39.

Almog G, Liebergall M, Tsafrir A, Barzilay Y, Mosheiff R (2007) Management of pelvic fractures during pregnancy. Am J Orthop (Belle Mead NJ) 36(11):E153–E159

40.

Lo BM, Downs EJ, Dooley JC (2009) Open-book pelvic fracture in late pregnancy. Pediatr Emerg Care 25(9):586–587PubMedCrossRef

41.

(1966) Cephalopelvic disproportion. Can Med Assoc J 94(21):1126–1127

Title: Risk factors and perinatal outcome of pregnancies complicated with cephalopelvic disproportion: a population-based study
Authors: Oren Tsvieli
Ruslan Sergienko
Eyal Sheiner
Publication date: 01-04-2012
Publisher: Springer-Verlag
Published in: Archives of Gynecology and Obstetrics / Issue 4/2012
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-011-2086-4

At a glance: The STEP trials

Springer Medicine

Risk factors and perinatal outcome of pregnancies complicated with cephalopelvic disproportion: a population-based study

Abstract

Objectives

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2012

Efficacy and safety of mifepristone and buccal misoprostol versus buccal misoprostol alone for medical abortion

The preoperative diagnosis of borderline ovarian tumors: a review of current literature

Laparoscopic pelvic lymphadenectomy: experience of a Gynaecological Cancer Centre in the UK

Coenzyme Q10 content in follicular fluid and its relationship with oocyte fertilization and embryo grading

Comparative evaluation of isosorbide mononitrate and alendronate in management of postmenopausal osteoporosis

Risk factors and microbial isolates of puerperal sepsis at the University of Maiduguri Teaching Hospital, Maiduguri, North-eastern Nigeria