Predictive factors for emergency cesarean section in grand multiparous compared to primiparous and multiparous women

OBJECTIVE: To identify predictive factors for emergency cesarean section (CS) in grand multiparous women and compare them with primiparous and multiparous women. METHODS: This was a retrospective cohort study in a single large university-affiliated tertiary medical center between 2011 and 2018, analyzing all women with singleton pregnancies that resulted in live births (n = 74 848). Women were grouped into three categories: primiparous (PP, first birth), multiparous (MP, 2-4 births), and grand multiparous (GMP, ≥5 births). Delivery characteristics and indications for emergency CS were analyzed. Univariate analyses assessed associations between potential risk factors and mode of delivery, stratified by gestational age (37-39 weeks and ≥40 weeks). Multivariable logistic regression was used to identify factors independently associated with emergency CS in each group. RESULTS: Proportion of emergency CS and its indications across parity groups. Emergency CS rates were significantly higher in the PP group (13.2%) than in the MP (9.4%) and GMP (6.5%) groups (P < 0.001). In stratified univariate analysis, emergency CS was significantly associated with advanced maternal age, higher body mass index (BMI), non-spontaneous conception, diabetes, and artificial rupture of membranes in both gestational age subgroups. Non-reassuring fetal heart rate (NRFHR) was the leading indication for emergency CS in GMP women (71.1%), followed by failure to progress (21.0%), suspected placental abruption (4.4%), suspected uterine rupture (2.6%), and failed instrumental delivery (0.9%). Multivariable analysis identified the following factors as significantly associated with increased risk of emergency CS: assisted reproductive technology (adjusted odds ratio [aOR] = 2.09, 95% confidence interval [CI]: 1.88-2.32), prolonged latency >12 h post-rupture of membranes (aOR = 2.08, 95% CI: 1.85-2.34), smoking (aOR = 1.49, 95% CI: 1.26-1.75), and diabetes (aOR = 1.46, 95% CI: 1.32-1.62). CONCLUSION: Grand multiparous women had a lower risk of emergency CS than primiparous and multiparous women. Non-reassuring fetal heart rate was the most common indication for emergency CS. Assisted reproductive technology (ART), prolonged rupture of membranes (ROM) latency, smoking, and diabetes were independent predictors of emergency CS.