Validation of risk scoring scheme for cesarean delivery due to cephalopelvic disproportion in Lamphun Hospital.

OBJECTIVE: To validate the risk scoring scheme for cesarean delivery due to cephalopelvic disproportion in Lamphun Hospital. MATERIAL AND METHOD: A case-control study was conducted between January 1st, 2005 and April 30th, 2006, including, prospectively collected, 132 women who had cesarean delivery due to cephalopelvic disproportion (CPD) as cases and 394 women who delivered by normal labor as controls. Cases and controls were evaluated for risk scores, the scoring scheme of which had previously been developed. The prediction by the risk score was tested with an area under the receiver operating characteristic (ROC) curve of a logistic regression. Another independent set of obstetric cases referred form community hospitals in Lamphun were also evaluated for the risk scores. RESULTS: The risk scores explained 84.5% of the probability of CPD as demonstrated by the area under the ROC curve. The scores of pregnant women referred from rural hospital underwent cesarean delivery were higher than those with vacuum extraction and with normal delivery (mean = 9.2 +/- 2.4, 7.5 +/- 3.2 and 6.4 +/- 2.3 respectively). The score of cesarean delivery was significantly higher than normal delivery (p < 0.001) while the score of vacuum extraction was in between and only slightly higher (p = 0.116). CONCLUSION: Risk scores obtained form this scoring scheme predicted cesarean delivery with high precision. The scores also discriminated cesarean deliveries from normal deliveries among cases referred from community hospitals. Community hospitals may gain benefit by adopting this simple scoring scheme into their practices.

Risk indicators for cesarean section due to cephalopelvic disproportion in Lamphun hospital.

OBJECTIVE: To investigate risk indicators for cesarean section due to cephalopelvic disproportion. SETTING: Department of Obstetrics & Gynecology, Lamphun Hospital. DESIGN: Case-control study. MATERIAL AND METHOD: Cases were 87 pregnant women delivered by cesarean section due to cephalopelvic disproportion at Lamphun Hospital between October 1st, 2003 and June 30th, 2004. Controls were 113 pregnant women delivered by normal labour during the same period. Maternal age, gravidity, parity, maternal height, pre-pregnancy weight, gestational age, weight before delivery, weight gain, symphysis-fundal height, birthweight and newborn gender were mainly focused. Information were obtained from medical records. Groups were compared by t-test and exact probability test as appropriate. Risk indicators were analyzed by odds ratio from univariable and multiviariable logistic regression. RESULTS: Risk indicators significantly associated with cesarean section due to cephalopelvic disproportion included symphysis-fundal height greater than 35 cm. (OR = 9.38, 95% CI = 3.42-25.73); nulliparity (OR = 5.36, 95%CI = 2.24-12.82); maternal height less than 152 cm. (OR = 3.65, 95%CI = 1.63-8.17) and weight gain more than 15 kg. (OR = 2.67, 95%C1 = 1.32-5.39). CONCLUSION: Risk factors for cesarean section due to cephalopelvic disproportion included symphysis-fundal height greater than 35 cm, nulliparity, maternal height less than 152 cm. and weight gain more than 15 kg. Early detection of these risk indicators before delivery helps obstetricians and nurses to recognize potential obstructed labor and prepare for safe delivery in advance.