Morales-Roselló José, Novillo-Del Álamo Blanca, Martínez-Varea Alicia
Department of Obstetrics and Gynecology, La Fe University and Polytechnic Hospital, Valencia, Spain (Morales-Roselló, Novillo-Del Álamo and Martínez-Varea).
Department of Pediatrics, Obstetrics, and Gynecology, Faculty of Medicine, University of Valencia, Valencia, Spain (Morales-Roselló).
AJOG Glob Rep. 2024 Oct 17;4(4):100415. doi: 10.1016/j.xagr.2024.100415. eCollection 2024 Nov.
The incidence of cesarean section (CS) for failure to progress (FP) has progressively increased; thus, knowing the factors that increase this incidence has become of crucial importance. This study aimed to find the true determinants of CS for FP within 2 weeks of delivery, proposing strategies to reduce its incidence.
A group of 957 term and late preterm (≥34 weeks) singleton pregnancies with a complete gestational follow-up and an ultrasound examination within 2 weeks of delivery were included in a retrospective observational study. Epidemiological, sonographic, and perinatal data were recorded, and multivariable logistic regression analyses were applied to create models to predict the importance of different variables in the explanation of FP.
Induction of labor was by far the most important modifiable factor, followed by smoking and maternal weight, while parity was the most important nonmodifiable factor, followed by maternal age and estimated fetal weight. The difference in days from the actual due date exerted no influence.
To reduce the incidence of CS for FP, inductions of labor should be performed only under evidence-based medicine indications and kept to a minimum. In addition, maternal overweight reduction and maternal smoking cessation should be promoted before the initiation of gestation.
因产程无进展而行剖宫产（CS）的发生率呈逐渐上升趋势；因此，了解增加该发生率的因素变得至关重要。本研究旨在找出分娩后2周内因产程无进展而行剖宫产的真正决定因素，并提出降低其发生率的策略。
一项回顾性观察性研究纳入了957例足月及晚期早产（≥34周）单胎妊娠，这些妊娠均有完整的孕期随访且在分娩后2周内进行了超声检查。记录了流行病学、超声及围产期数据，并应用多变量逻辑回归分析建立模型，以预测不同变量在解释产程无进展方面的重要性。
引产是迄今为止最重要的可改变因素，其次是吸烟和孕妇体重，而产次是最重要的不可改变因素，其次是孕妇年龄和估计胎儿体重。与实际预产期的天数差异没有影响。
为降低因产程无进展而行剖宫产的发生率，引产应仅在循证医学指征下进行，并尽量减少。此外，应在妊娠开始前促进孕妇减轻超重和戒烟。
