Archives of Gynecology and Obstetrics

, Volume 288, Issue 5, pp 1027–1033 | Cite as

Prediction of dystocia-related cesarean section risk in uncomplicated Taiwanese nulliparas at term

  • Chiung-Hui WuEmail author
  • Chiu-Fen Chen
  • Chi-Chen Chien
Maternal-Fetal Medicine



We aimed to assess risk factors for dystocia-related cesarean section (CS) in uncomplicated Taiwanese nulliparas at term


We reviewed 1,272 deliveries by 1 obstetrician in a Taiwanese hospital between February 2004 and December 2011. These parturients were nulliparas with singleton pregnancies ≥37 weeks gestation who had liveborn cephalic deliveries. The CS group consisted of parturients with dystocia-related CS for the following indications: prolonged latent phase, failure to progress, or arrest of descent. Eight confounding variables [maternal age, height, weight, body mass index (BMI) in labor, gestational age, infant birth weight, gender, and cervical dilatation] were obtained from the medical records. Multivariate logistic regression analysis was used to determine the association between each variable and route of delivery. A predictive formula for CS probability was generated using a logistic regression model.


Overall 15.0 % of nulliparas in our population underwent CS. Logistic regression analysis revealed a significant association between maternal BMI and CS (adjusted OR 1.112; 95 % CI 1.065–1.161; P < 0.001). The association between maternal age and CS was also statistically significant (adjusted OR 1.074, 95 % CI 1.033–1.116, P = 0.001). Maternal height, weight in labor, gestational age, infant birth weight, gender, and cervical dilatation were not significantly associated with the route of delivery. A predictive formula for CS probability was developed based on a combination of maternal BMI and age.


Our results show that maternal age and BMI in labor are significantly associated with dystocia-related CS in uncomplicated Taiwanese nulliparas at term. We develop a practical formula to predict the probability for CS. Using this formula, obstetricians can estimate the risk of CS according to maternal age and BMI in labor.


Dystocia Cesarean section Body mass index Maternal age Nullipara 



The author thanks Jack Y. J. Huang MD, Ph.D. for editing.

Conflict of interest



  1. 1.
    Cnattingius R, Cnattingius S, Notzon FC (1998) Obstacles to reducing cesarean rates in a low-cesarean setting: the effect of maternal age, height, and weight. Obstet Gynecol 92:501–506PubMedCrossRefGoogle Scholar
  2. 2.
    Bureau of Health Promotion, Department of Health, Executive Yuan, R.O.C. (Taiwan). Web site: Accessed 1 Nov 2012
  3. 3.
    Statistics and Information Department, Minister’s Secretariat, Ministry of Health, Labour and Welfare. Survey of Medical Institutions. Accessed 1 July 2010
  4. 4.
    Häger RM, Daltveit AK, Hofoss D, Nilsen ST, Kolaas T, Øian P et al (2004) Complications of cesarean deliveries: rates and risk factors. Am J Obstet Gynecol 190:428–434PubMedCrossRefGoogle Scholar
  5. 5.
    Lumbiganon P, Laopaiboon M, Gülmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P et al (2010) Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007–08. Lancet 375:490–499PubMedCrossRefGoogle Scholar
  6. 6.
    Chen G, Uryasev S, Young TK (2004) On prediction of the cesarean delivery risk in a large private practice. Am J Obstet Gynecol 191:617–625CrossRefGoogle Scholar
  7. 7.
    Young TK, Woodmansee B (2002) Factors that are associated with cesarean delivery in a large private practice: the importance of prepregnancy body mass index and weight gain. Am J Obstet Gynecol 187:312–320PubMedCrossRefGoogle Scholar
  8. 8.
    Nuthalapaty FS, Rouse DJ, Owen J (2004) The association of maternal weight with cesarean risk, labor duration, and cervical dilation rate during labor induction. Obstet Gynecol 103:452–456PubMedGoogle Scholar
  9. 9.
    Kelly A, Kevany J, de Onis M, Shah PM (1996) A WHO Collaborative Study of Maternal Anthropometry and Pregnancy Outcomes. Int J Gynaecol Obstet 53:219–233PubMedCrossRefGoogle Scholar
  10. 10.
    Sheiner E, Levy A, Katz M, Mazor M (2005) Short stature—an independent risk factor for Cesarean delivery. Eur J Obstet Gynecol Reprod Biol 120:175–178PubMedCrossRefGoogle Scholar
  11. 11.
    Møller B, Lindmark G (1997) Short stature: an obstetric risk factor? A comparison of two villages in Tanzania. Acta Obstet Gynecol Scand 76:394–397PubMedCrossRefGoogle Scholar
  12. 12.
    Kara F, Yesildaglar N, Uygur D (2005) Maternal height as a risk factor for Caesarean section. Arch Gynecol Obstet 271:336–337PubMedCrossRefGoogle Scholar
  13. 13.
    ACOG Practice Bulletin (2003) Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol 102:1445–1454Google Scholar
  14. 14.
    Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY (2010) Abnormal labor. In: Fried A, Davis K (eds) Williams Obstetrics, 23rd edn. The McGraw-Hill Companies, Inc., New York, pp 464–489Google Scholar
  15. 15.
    Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY (2010) Normal labor and delivery. In: Fried A, Davis K (eds) Williams Obstetrics, 23rd edn. The McGraw-Hill Companies, Inc., New York, pp 374–409Google Scholar
  16. 16.
    Kominiarek MA, Vanveldhuisen P, Hibbard J, Landy H, Haberman S, Learman L, et al (2010) The maternal body mass index: a strong association with delivery route. Am J Obstet Gynecol 203:264.e1–7Google Scholar
  17. 17.
    Fyfe EM, Anderson NH, North RA, Chan EH, Taylor RS, Dekker GA et al (2011) Risk of first-stage and second-stage cesarean delivery by maternal body mass index among nulliparous women in labor at term. Obstet Gynecol 117:1315–1322PubMedCrossRefGoogle Scholar
  18. 18.
    Dietz PM, Callaghan WM, Morrow B, Cogswell ME (2005) Population-based assessment of the risk of primary cesarean delivery due to excess prepregnancy weight among nulliparous women delivering term infants. Matern Child Health J 9:237–244PubMedCrossRefGoogle Scholar
  19. 19.
    Vahratian A, Zhang J, Troendle JF, Savitz DA, Siega-Riz AM (2004) Maternal prepregnancy overweight and obesity and the pattern of labor progression in term nulliparous women. Obstet Gynecol 104:943–951PubMedCrossRefGoogle Scholar
  20. 20.
    Takimoto H, Sugiyama T, Nozue M, Kusama K, Fukuoka H, Kato N et al (2011) Maternal antenatal body mass index gains as predictors of large-for-gestational-age infants and cesarean deliveries in Japanese singleton pregnancies. J Obstet Gynaecol Res 37:553–562. doi: 10.1111/j.1447-0756.2010.01396.x PubMedCrossRefGoogle Scholar
  21. 21.
    Isono W, Nagamatsu T, Uemura Y, Fujii T, Hyodo H, Yamashita T et al (2011) Prediction model for the incidence of emergent cesarean section during induction of labor specialized in nulliparous low-risk women. J Obstet Gynaecol Res 37:1784–1791. doi: 10.1111/j.1447-0756.2011.01607.x PubMedCrossRefGoogle Scholar
  22. 22.
    Zhang J, Bricker L, Wray S, Quenby S (2007) Poor uterine contractility in obese women. Br J Obstet Gynaecol 114:343–348CrossRefGoogle Scholar
  23. 23.
    Parrish KM, Holt VL, Easterling TR, Connell FA, LoGerfo JP (1994) Effect of changes in maternal age, parity, and birth weight distribution on primary cesarean delivery rates. JAMA 271:443–447PubMedCrossRefGoogle Scholar
  24. 24.
    Main DM, Main EK, Moore DH 2nd (2000) The relationship between maternal age and uterine dysfunction: a continuous effect throughout reproductive life. Am J Obstet Gynecol 186:1312–1320CrossRefGoogle Scholar
  25. 25.
    Ecker JL, Chen KT, Cohen AP, Riley LE, Lieberman ES (2001) Increased risk of cesarean delivery with advancing maternal age: indications and associated factors in nulliparous women. Am J Obstet Gynecol 185:883–887PubMedCrossRefGoogle Scholar
  26. 26.
    Rosenthal AN, Paterson-Brown S (1998) Is there an incremental rise in the risk of obstetric intervention with increasing maternal age? Br J Obstet Gynaecol 105(10):1064–1069PubMedCrossRefGoogle Scholar
  27. 27.
    Sports Affairs Council, Executive Yuan, R.O.C. (Taiwan). Web site: Accessed 1 Nov 2012
  28. 28.
    Buschur E, Kim C (2012) Guidelines and interventions for obesity during pregnancy. Int J Gynaecol Obstet 119:6–10. doi: 10.1016/j.ijgo.2012.04.025 PubMedCrossRefGoogle Scholar
  29. 29.
    Bishop EH (1964) Pelvic scoring for elective induction. Obstet Gynecol 24:266–268PubMedGoogle Scholar
  30. 30.
    Crane JM (2006) Factors predicting labor induction success: a critical analysis. Clin Obstet Gynecol 49:573–584PubMedCrossRefGoogle Scholar
  31. 31.
    Watson WJ, Stevens D, Welter S, Day D (1996) Factors predicting successful labor induction. Obstet Gynecol 88:990–992PubMedCrossRefGoogle Scholar
  32. 32.
    Reis FM, Gervasi MT, Florio P, Bracalente G, Fadalti M, Severi FM, Petraglia F (2003) Prediction of successful induction of labor at term: role of clinical history, digital examination, ultrasound assessment of the cervix, and fetal fibronectin assay. Am J Obstet Gynecol 189:1361–1367PubMedCrossRefGoogle Scholar
  33. 33.
    Laughon SK, Zhang J, Troendle J, Sun L, Reddy UM (2011) Using a simplified Bishop score to predict vaginal delivery. Obstet Gynecol 117:805–811. doi: 10.1097/AOG.0b013e3182114ad2 PubMedCrossRefGoogle Scholar
  34. 34.
    Peregrine E, O’Brien P, Omar R, Jauniaux E (2006) Clinical and ultrasound parameters to predict the risk of cesarean delivery after induction of labor. Obstet Gynecol 107:227–233PubMedCrossRefGoogle Scholar
  35. 35.
    Verhoeven CJ, Oudenaarden A, Hermus MA, Porath MM, Oei SG, Mol BW (2009) Validation of models that predict Cesarean section after induction of labor. Ultrasound Obstet Gynecol 34:316–321. doi: 10.1002/uog.7315 PubMedCrossRefGoogle Scholar
  36. 36.
    Uyar Y, Erbay G, Demir BC, Baytur Y (2009) Comparison of the Bishop score, body mass index and transvaginal cervical length in predicting the success of labor induction. Arch Gynecol Obstet 280:357–362PubMedCrossRefGoogle Scholar
  37. 37.
    Gould JB, Davey B, Stafford RS (1989) Socioeconomic differences in rates of cesarean section. N Eng J Med 321:233–239CrossRefGoogle Scholar
  38. 38.
    Feng XL, Xu L, Guo Y, Ronsmans C (2012) Factors influencing rising caesarean section rates in China between 1988 and 2008. Bull World Health Organ 90:30–39. doi: 10.2471/BLT.11.090399 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyTon-Yen General HospitalJhubei CityTaiwan, ROC
  2. 2.Yi-En ClinicZhongli CityTaiwan, ROC

Personalised recommendations