Intrapartum cesarean delivery in nulliparas: risk factors compared by two analytical approaches

J Perinatol. 2015 Mar;35(3):167-72. doi: 10.1038/jp.2014.179. Epub 2014 Sep 25.


Objective: To determine risk factors for cesarean delivery in nulliparas at labor admission.

Study design: Nulliparas with live-born, singleton gestations ⩾37 weeks in spontaneous or induced labor were analyzed from the Consortium on Safe Labor database in a retrospective observational study. Classification and regression tree (CART) and multivariate logistic regression analysis determined risk factors for cesarean delivery.

Result: Of the 66 539 nulliparas, 22% had a cesarean delivery. In the CART analysis, the first cervical dilation exam was the first branch followed by body mass index (BMI). Cesarean deliveries occurred in 45%, 25%, 14% and 10% of deliveries at <1, 1 to 3, 4 and ⩾5 cm dilated, respectively. The BMI influence was most evident in the <1 cm dilation category with 26% of BMI <25 kg m(-2) and 66% of BMI ⩾40 kg m(-2) having a cesarean delivery. The fewest cesarean deliveries (5%) occurred in those ⩾5 cm and BMI <25 kg m(-2). In the multivariate regression analysis, first cervical dilation exam <1 cm (odds ratio (OR) 5.1, 95% confidence interval (CI): 4.5 to 5.7; reference ⩾5 cm) and BMI ⩾40 kg m(-2) (OR 5.1, 95% CI: 4.6 to 5.7; reference BMI <25.0 kg m(-2)) had the highest odds for cesarean delivery.

Conclusion: Cervical dilation on admission followed by BMI were the two most important risk factors for cesarean delivery identified in both CART and multivariate regression analysis.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural

MeSH terms

  • Adult
  • Body Mass Index
  • Cesarean Section / statistics & numerical data*
  • Delivery, Obstetric / methods*
  • Female
  • Gestational Age
  • Humans
  • Labor, Induced
  • Labor, Obstetric
  • Logistic Models
  • Multivariate Analysis
  • Odds Ratio
  • Parity
  • Pregnancy
  • Retrospective Studies
  • Risk Factors
  • Young Adult