Saturday, January 20, 2018

Sonographically measured fetal head circumference ≥35 cm at term increases the odds of cesarean delivery.


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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