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

Objective: To identify predictive factors for intrapartum cesarean section (CS) in grand multiparous women and compare them with primiparous and multiparous women. Design: and Setting: A historical cohort study in a single university-affiliated tertiary medical center. Population: All women with singleton pregnancies resulted in live births (n = 74,848) between 2011-2018. Women were categorized into three groups: primiparous (PP, first birth), multiparous (MP, 2–4 births), and grand multiparous (GMP, ≥5 births). Methods: : We analyzed delivery characteristics and indications for intrapartum emergency CS. We then used multivariate logistic regression to identify factors associated with an increased risk of emergency CS. Main Outcome Measures: Proportion of intrapartum CS and its indications among the parity groups. Results: : Intrapartum CS rates were significantly higher in the PP group (13.2%) compared to MP (9.4%) and GMP + GGMP (6.5%) (p <.001). Non-reassuring fetal heart rate (NRFHR) was the leading indication for intrapartum 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%). Multivariate analysis identified the following factors as significantly associated with increased risk of emergency CS: assisted reproductive technology (aOR = 2.09, 95% CI 1.88–2.32), prolonged latency >12 hours post-rupture of membranes (aOR = 2.08, 95% CI 1.85–2.34), tobacco use (aOR = 1.49, 95% CI 1.26–1.75), and diabetes (aOR = 1.46, 95% CI 1.32–1.62). Conclusions: : Grand multiparous women had a lower risk for intrapartum CS compared to 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, tobacco use, and diabetes were independent predictors of intrapartum CS.