The SaTH risk-assessment tool for the prediction of emergency cesarean section in women having induction of labor for all indications: a large-cohort based study.
OBJECTIVE
To develop a risk-assessment model for the prediction of emergency cesarean section (CS) in women having induction of labor (IOL).


METHODS
This was an observational cohort study of women with IOL for any indication between 2007 and 2013. Women induced for stillbirths and with multiple pregnancies were excluded. The primary objective was to identify risk factors associated with CS delivery and to construct a risk-prediction tool.


RESULTS
6169 women were identified with mean age of 28.9 years. Primiparity involved 47.1 %, CS rate was 13.3 % and post-date pregnancies were 32.4 %. Risk factors for CS were: age >30 years, BMI >25 kg/m2, primiparity, black-ethnicity, non post-date pregnancy, meconium-stained liquor, epidural analgesia, and male fetal gender. Each factor was assigned a score and with increasing scores the CS rate increased. The CS rate was 5.4 % for a score <11, while for a score ≥11 it increased to 25.0 %. The model had a sensitivity, specificity, negative predictive value and positive predictive value of 75.8, 65.1, 93.8 and 25.0 %, respectively.


CONCLUSIONS
We have constructed a risk-prediction tool for CS delivery in women with IOL. The risk-assessment tool for the prediction of emergency CS in induced labor has a high negative-predictive value and can provide reassurance to presumed low-risk women.
Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals, NHS Trust, Apley Castle, Grainger Drive, Telford, TF16TF, UK. dimitrios.papoutsis@nhs.net.
Dimitrios
D
Papoutsis
Department of Midwifery, Midwifery School, 'Alexander' Technological Educational Institute of Thessaloniki, Thessaloniki, Greece.
Angeliki
A
Antonakou
Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals, NHS Trust, Apley Castle, Grainger Drive, Telford, TF16TF, UK.
Adam
A
Gornall
Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece.
Chara
C
Tzavara
Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals, NHS Trust, Apley Castle, Grainger Drive, Telford, TF16TF, UK.
Michelle
M
Mohajer
D000328:Adult; D002585:Cesarean Section; D015331:Cohort Studies; D004630:Emergencies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000706:statistics & numerical data; D008297:Male; D011247:Pregnancy; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
Cesarean section; Delivery; Ethnicity; Gender; Induced labor