Sonographically
measured fetal head circumference ≥35 cm, within a week of delivery increases
the odds of unplanned cesarean section by 75% reports the results of
multicenter observational study accepted for publication in American Journal of
Obstetrics and Gynecology.
Currently, In
US, one in every third baby is born by cesarean section and the high rate is a
cause of concern for healthcare industry.
Physicians
and patients will be greatly benefited by knowing more about factors that can
predict the risk of cesarean section, in terms of better patient counselling
and individual labor planning. Besides obstetrics factors, earlier studies have
focused on estimated baby weight as a predictor of increased risk of operative and
instrumental delivery.
This medical
record based study looked at labor outcome of 11,500 primiparous women, presenting
at term (37-42 weeks) with singleton fetuses in cephalic presentation for
ultrasound with fetal biometry within one week of delivery.
All the
patients who had an elective cesarean section were excluded from the study.
It was seen
that head circumference ≥35 cm increased the odds of cesarean section by 2.5
times and increased the risk of instrumental intervention by 48%.
Increased
head circumference and EFW ≥3900 also increased the risk of prolonged second
stage of labor in the study cohort. At the same time head circumference ≥35 cm
was significantly associated with improved Apgar score (p=0.01).
The authors
concluded that Sonographic fetal head circumference ≥35 cm increased the second
stage of labor and is also an independent risk factor for cesarean delivery.
Paired with EFW,
increased head circumference ≥35 cm, can be useful for patient counselling and
planning the labor.
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