Which factors before labour induction at term are associated with a higher chance of Caesarean delivery?

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The study assessed whether ultrasound measurements of amniotic fluid, fetal weight, cervical length and cervical funneling, together with clinical factors, were related to the risk of Caesarean delivery after labour induction at term.

A total of 152 women scheduled for labour induction at term agreed to participate. In this observational study, sonography was used to obtain fetal biometry, amniotic fluid index and cervical length, and to detect funneling at the internal cervical os. The ultrasound findings were concealed. Participants received standard care during labour induction.

In univariate analysis using Fisher's exact test, parity, cervical length and Bishop score were associated with Caesarean delivery. In multivariable logistic regression analysis, only nulliparity—having no previous births—and a cervical length greater than 20 mm measured by transvaginal ultrasound were independent predictors of Caesarean delivery during labour induction. For nulliparity, the adjusted odds ratio (AOR) was 5.2 (95% confidence interval 2.2–12.2; P<0.001). For cervical length greater than 20 mm, the AOR was 2.8 (95% confidence interval 1.0–7.4; P=0.04).

Maternal age, maternal height, gestational age, the indication for labour induction, amniotic fluid index, cervical funneling and ultrasound-estimated fetal weight did not predict Caesarean delivery.

The authors concluded that, among women undergoing labour induction at term with a singleton fetus, nulliparity and a cervical length greater than 20 mm on transvaginal sonography were independent predictors of Caesarean delivery. They considered this information helpful for counselling before induction.