Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
J Obstet Gynaecol Res. 2024 Aug;50(8):1383-1391. doi: 10.1111/jog.15974. Epub 2024 May 22.
This study aimed to examine maternal and neonatal factors in cesarean deliveries due to dystocia, including cephalopelvic disproportion, latent-phase prolongation, and fetal malposition or malpresentation. Additionally, we sought to compare the differences between the dystocia subgroups.
This retrospective case-control study included women who delivered between January 2010 and June 2021 after 37 weeks of pregnancy and underwent abdominal-pelvic CT scans within 5 years before and after delivery. Neonatal factors were extracted from medical charts immediately after delivery.
Among the 292 women studied, those with cesarean deliveries for dystocia were older (mean ± SD, 34.2 ± 4.27 vs. 32.2 ± 3.8, p-value = 0.002), had higher pre-pregnancy BMI (22.7 ± 3.67 vs. 21.4 ± 3.48, p-value = 0.012) and term-BMI (27.4 ± 3.72 vs. 25.9 ± 3.66, p-value = 0.010), shorter interspinous distance (ISD, the distance between ischial spine) (10.8 ± 0.76 vs. 11.2 ± 0.85 cm, p-value = 0.003), and longer head circumference (HC) (35 ± 1.47 vs. 34.4 ± 1.36 cm, p-value = 0.003) compared to those who had vaginal deliveries. Univariate logistic regression for dystocia revealed associations between HC/maternal height and HC/ISD ratios (OR, 2.02 [95% confidence interval, CI, 1.4 ~ 2.92], 12.13 [3.2 ~ 46.04], respectively). Multivariate logistic analysis indicated that maternal age, ISD, and HC were significant factors for dystocia (OR, 1.11 [95% CI, 1.01 ~ 1.21], 0.49 [0.26 ~ 0.91], 1.53 [1.07 ~ 2.19], respectively). The subgroup with latent-phase prolongation exhibited the lowest birthweight/term-BMI ratio (124 ± 18.8 vs. 113 ± 10.3 vs. 134 ± 19.1, p-value = 0.013).
The HC/ISD ratio emerged as a crucial predictor of dystocia, suggesting that reducing term-BMI could potentially mitigate latent-phase prolongation. Further research assessing the maternal mid-pelvis during pregnancy and labor is warranted, along with efforts to reduce BMI during pregnancy.
本研究旨在探讨因难产而行剖宫产的产妇和新生儿因素，包括头盆不称、潜伏期延长、胎儿位置不正或胎方位不正。此外，我们还比较了难产亚组之间的差异。
这是一项回顾性病例对照研究，纳入了 2010 年 1 月至 2021 年 6 月期间妊娠 37 周后分娩的女性，以及在分娩前 5 年内和分娩后立即从病历中提取新生儿因素。
在 292 名研究对象中，因难产而行剖宫产的产妇年龄更大（均值±标准差，34.2±4.27 岁 vs. 32.2±3.8 岁，p 值=0.002），孕前 BMI 更高（22.7±3.67 千克/平方米 vs. 21.4±3.48 千克/平方米，p 值=0.012）和足月 BMI 更高（27.4±3.72 千克/平方米 vs. 25.9±3.66 千克/平方米，p 值=0.010），坐骨棘间距离（ISD，坐骨棘之间的距离）更短（10.8±0.76 厘米 vs. 11.2±0.85 厘米，p 值=0.003），头围（HC）更大（35±1.47 厘米 vs. 34.4±1.36 厘米，p 值=0.003）。难产的单因素 logistic 回归分析显示，HC/母体身高比和 HC/ISD 比与难产有关（OR，2.02[95%置信区间，CI，1.42.92]，12.13[3.246.04]）。多因素 logistic 分析表明，产妇年龄、ISD 和 HC 是难产的显著因素（OR，1.11[95%CI，1.011.21]，0.49[0.260.91]，1.53[1.07~2.19]）。潜伏期延长亚组的出生体重/足月 BMI 比值最低（124±18.8 克/千克 vs. 113±10.3 克/千克 vs. 134±19.1 克/千克，p 值=0.013）。
HC/ISD 比值是难产的一个重要预测指标，表明降低足月 BMI 可能有助于减轻潜伏期延长。有必要进一步评估妊娠和分娩期间产妇中骨盆的情况，并努力降低孕期 BMI。
