[Cesarean after labor induction: Risk factors and prediction score].

OBJECTIVES

The objective of the study is to determine the risk factors for caesarean section at the time of labor induction, to establish a prediction algorithm, to evaluate its relevance and to compare the results with observation.

METHODS

A retrospective study was carried out over a year at Nantes University Hospital with 941 cervical ripening and labor inductions (24.1%) terminated by 167 caesarean sections (17.8%). Within the cohort, a case-control study was conducted with 147 caesarean sections and 148 vaginal deliveries. A multivariate analysis was carried out with a logistic regression allowing the elaboration of an equation of prediction and an ROC curve and the confrontation between the prediction and the reality.

RESULTS

In univariate analysis, six variables were significant: nulliparity, small size of the mother, history of scarried uterus, use of prostaglandins as a mode of induction, unfavorable Bishop score<6, variety of posterior release. In multivariate analysis, five variables were significant: nulliparity, maternal size, maternal BMI, scar uterus and Bishop score. The most predictive model corresponded to an area under the curve of 0.86 (0.82-0.90) with a correct prediction percentage ("well classified") of 67.6% for a caesarean section risk of 80%.

CONCLUSION

The prediction criteria would make it possible to inform the woman and the couple about the potential risk of Caesarean section in urgency or to favor a planned Caesarean section or a low-lying attempt on more objective, repeatable and transposable arguments in a medical team.