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Labor

Poster Session 4

(1076) Risk Factors Predictive of Cesarean Section for Non-reassuring Fetal Heart Tracing among Inductions

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: To identify risk factors for patients needing a cesarean delivery for fetal distress while undergoing induction of labor.

Study Design:

In a retrospective case-control study design, every patient undergoing induction of labor and who delivered via a cesarean section for a non-reassuring fetal heart tracing (FHT) over a 12-month period at Brigham and Women’s Hospital were included as cases. Patients who were attempting a trial of labor after a prior cesarean section were excluded. Controls were defined as the next scheduled induction who delivered either vaginally or via cesarean delivery for other indications. A multivariate logistic regression model was built based on significant univariate findings to identify risk factors for needing a cesarean delivery for fetal distress during induction.


Results:

A total of 142 cases and 148 controls were included. The significant associations are reported in the table below. Spanish speakers, nulliparity, need for cervical ripening, fetal growth restriction, and having a category II FHT within the first hour of induction were independent significant predictors of having cesarean delivery for fetal distress. When these risk factors were combined, it was found that nulliparous patients who require cervical ripening and have a category II FHT within the first hour of induction have an adjusted OR of 3.7 (95% CI 1.8-7.6, p< 0.001).  


Conclusion:

These findings suggest that certain maternal, fetal, and labor factors at the start of induction may be predictive of needing a cesarean delivery for fetal distress later in induction. Additionally, the cumulative effect of these factors suggests that a certain patient population (i.e. nulliparous patients with an unfavorable cervix and a category II FHT within the first hour of induction) may have a higher risk of ultimately needing a cesarean section during induction, which can help inform and guide patient counseling. These findings could be used to help build a predictive model that combines variables prior to induction of labor to identify pregnancies at increased risk of cesarean delivery for fetal distress.