title: Factors affecting mode of delivery in a nullipara at term with singleton pregnancy and vertex presentation (NTSV).
abstract: OBJECTIVE
  To analyse the factors associated with Caesarean Section (CS) of Nulliparous, Term and Singleton pregnancies with Vertex presentation (NTSV) at a tertiary care hospital.
  
  
  METHODS
  In this unmatched retrospective case-control study, 212 NTSV patients were identified through computerized medical record systems; the data was collected through predesigned Performa by reviewing medical record charts. One hundred six CS and spontaneous vaginal deliveries (SVD) were taken as cases and controls.
  
  
  RESULTS
  The mean maternal age of cases (CS) was 26.64 (SD: 3.9) and of controls (SVD) was 26.7(SD: 3.9) years, whereas mean gestational age was 38.66±1.12 and 38.57±0.9 weeks for cases and controls respectively. Ninety per cent of women in the study group were delivered within 10 hours of active labour. Babies that weighed ≤3kg were 45% and >3kg were 55%. The possibility of being high risk was twice more among those delivered by CS. However, it was not statistically significant (p value 0.077). Labour was induced in 38% patients. The Odds of Induction of Labour (IOL) were two times more and delivering at night was three times more amongst CS. The likelihood of labour exceeding 10 hours was four times (81%) if the patient had a CS. Moreover 48% of the babies weighing >3kg were delivered through CS. Maternal age, high risk pregnancies, gender of baby and epidural analgesia were not statistically significant predictors of mode of delivery (MOD) in this study.
  
  
  CONCLUSIONS
  Induction of Labour, night time delivery, prolonged labour and birth weight <3kg were found to be associated with the increased CS rate among NTSV. Therefore further research is required in order to address these factors and to reduce the increasing Caesarean Section.
authors.affiliation: Dr. Iffat Ahmed, Senior Instructor, Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Iffat
authors.initials: I
authors.lastname: Ahmed
authors.affiliation: Dr. Uzma Chishti, Assistant Professor, Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Uzma
authors.initials: U
authors.lastname: Chishti
authors.affiliation: Dr. Munazza Akhtar, Senior Instructor, Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Munazza
authors.initials: M
authors.lastname: Akhtar
authors.affiliation: Ms. Humaira Ismail, Research Specialist, Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Humaira
authors.initials: H
authors.lastname: Ismail
keywords: Caesarean section; Induction of labour; Low risk pregnancy; Nulliparous; Singleton pregnancy; Term pregnancy; vertex presentation