(111) Establishing a Risk Score for Prediction of Intrapartum Cesarean Delivery among Elderly Gravidae.

We aimed to determine risk factors for intrapartum cesarean delivery (CD) in women over 40 years old, and to develop a risk prediction score for this outcome.

Study Design:

We conducted a retrospective cohort study, in a single university-affiliated tertiary medical center with approximately 12,500 deliveries annually (2012-2022). We included all women aged 40 years old or more, who planned a trial of labor and excluded women who opt for an elective CD or those with non-viable fetuses. Maternal and neonatal characteristics of women who delivered vaginally were compared to those who underwent an intrapartum CD.

Risk factors were examined using univariate analysis as well as multivariate logistic regression. A specific risk prediction score was developed in accordance with the relative risk, to predict the need for CD. The ROC curve was assessed utilizing the performance of our model. 

Results:

(1) During the study period, 6,122 women aged 40 years old or more attempted a trial of labor. Of them, 428 (7%), underwent an intrapartum CD.

(2) Using multivariate analysis, several independent risk factors for intrapartum CD were identified, including nulliparity, multiple gestations, induction of labor, epidural anesthesia, pre-eclampsia, gestational diabetes, and previous CD.  We attributed a risk score for each risk factor and included them in our score model. [Table]

(3) Our score model, employing a cut-off of 7, demonstrated successful prediction of intrapartum CD with an area under the curve of 0.85 (95%CI [0.83-0.87], p=0.009).  

Conclusion:

Assessment of risk factors before and during labor, using our risk score, can be used by caregivers to offer a more informed consultation to patients facing the decision among mode of delivery.