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Factors associated with caesarean section in nulliparous women: a multicentre prospective cohort study
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  • Sunita Panda,
  • Cecily Begley,
  • Paul Corcoran,
  • Deirdre Daly
Sunita Panda
Trinity College Dublin
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Cecily Begley
Trinity College Dublin
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Paul Corcoran
University College Cork
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Deirdre Daly
Trinity College Dublin
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Abstract

Objective: To identify the factors associated with birth by caesarean section (CS) in nulliparous women. Design: Prospective cohort study. Setting: Three maternity hospitals in the Republic of Ireland. Sample: A total of 3047 nulliparous women. Method: Data from self-administered surveys antenatally and at 3-months postpartum and hospital records of consenting women were included in the analysis. Poisson regression was used to assess associations between demographic and clinical factors and birth by CS. Main outcome measures: Planned and unplanned CS. Results: Of the 2755 women included in the analysis, 888 women (32.23%) had a CS (planned (n=166, 6.02%) and unplanned (n=722, 26.21%)). Common risk factors for planned and unplanned CS were being aged ≥40 years, being in private care, multiple pregnancy and fetus in breech or other malpresentations. An unplanned CS occurred for 22.43% (n=377/1681) of women who did not have induction of labour (IOL) or who had IOL with no epidural but the risk was about twice as high for women who had IOL and epidural (with intravenous oxytocin: ARR 1.70, 95% CI 1.44-2.01, p<0.001; without intravenous oxytocin: ARR 2.06, 95% CI 1.57-2.69, p<0.001); without IOL and epidural, >20% of the unplanned CSs would not have occurred. Conclusions: Findings confirm the multifactorial reasons for CS and the challenge of reversing the increasing CS rate if maternal age, overweight/obesity, infertility treatment, multiple pregnancy and pre-existing hypertension continue to increase, and highlight the need to address pre-labour interventions considering that IOL, with epidural, made the greatest contribution to risk of unplanned CS.