Am J Perinatol 2025; 42(02): 256-267
DOI: 10.1055/s-0044-1788274
Original Article

Fetal and Maternal Factors Predictive of Primary Cesarean Delivery at Term in a Low-Risk Population: NICHD Fetal Growth Studies—Singletons

1   Division of Maternal-Fetal Medicine, Atrium Health, Charlotte, North Carolina
,
Danielle R. Stevens
2   Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Katherine L. Grantz
2   Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Cuilin Zhang
3   Global Center for Asian Women's Health and the Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
4   Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
,
Jagteshwar Grewal
2   Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
William A. Grobman
5   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
,
John Owen
6   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama
,
Anthony C. Sciscione
7   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Christiana Hospital, Newark, Delaware
,
Ronald J. Wapner
8   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
,
Daniel Skupski
9   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York Presbyterian Queens, Flushing, New York and Weill Cornell Medicine, New York, New York
,
Edward Chien
10   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cleveland Clinic Health System, Cleveland, Ohio
,
Deborah A. Wing
11   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine, and Long Beach Memorial Medical Center/Miller Children's Hospital Irvine, California
,
Angela C. Ranzini
12   Department of Obstetrics and Gynecology. The MetroHealth System, Cleveland, Ohio; Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio
,
Michael P. Nageotte
13   Maternal-Fetal medicine Specialist, Miller Children's and Women's Hospital, Long Beach, California
,
Roger B. Newman
14   Division of Maternal-Fetal Medicine, Medical University of South Carolina, Charleston, South Carolina
› Author Affiliations

Funding This research was supported, in part, by the Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health; and, in part, by Federal Funds for the NICHD Fetal Growth Studies including ARRA funding (contract numbers: HHSN275200800013C; HHSN275200800002I; HHSN27500006; HHSN275200800003IC; HHSN275200800014C; HHSN275200800012C; HHSN275200800028C; and HHSN275201000009C). K.L.G. and J.G. have contributed to this work as part of their official duties as employees of the United States Federal Government.
Preview

Abstract

Objective This study aimed to examine associations of fetal biometric and amniotic fluid measures with intrapartum primary cesarean delivery (PCD) and develop prediction models for PCD based on ultrasound parameters and maternal factors.

Study Design Secondary analysis of the National Institute of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies—singleton cohort (2009–2013) including patients with uncomplicated pregnancies and intent to deliver vaginally at ≥370/7 weeks. The estimated fetal weight, individual biometric parameters, fetal asymmetry measurements, and amniotic fluid single deepest vertical pocket assessed at the final scan (mean 37.5 ± 1.9 weeks) were categorized as <10th, 10th to 90th (reference), and >90th percentiles. Logistic regression analyses examined the association between the ultrasound measures and PCD. Fetal and maternal SuperLearner prediction algorithms were constructed for the full and nulliparous cohorts.

Results Of the 1,668 patients analyzed, 249 (14.9%) had PCD. The fetal head circumference, occipital–frontal diameter, and transverse abdominal diameter >90th percentile (adjusted odds ratio [aOR] = 2.50, 95% confidence interval [95% CI]: 1.39, 4.51; aOR = 1.86, 95% CI: 1.02, 3.40; and aOR = 2.13, 95% CI: 1.16, 3.89, respectively) were associated with PCD. The fetal model demonstrated poor ability to predict PCD in the full cohort and in nulliparous patients (area under the receiver-operating characteristic curve [AUC] = 0.56, 95% CI: 0.52, 0.61; and AUC = 0.54, 95% CI: 0.49, 0.60, respectively). Conversely, the maternal model had better predictive capability overall (AUC = 0.79, 95% CI: 0.75, 0.82) and in the nulliparous subgroup (AUC = 0.72, 95% CI: 0.67, 0.77). Models combining maternal/fetal factors performed similarly to the maternal model (AUC = 0.78, 95% CI: 0.75, 0.82 in full cohort, and AUC = 0.71, 95% CI: 0.66, 0.76 in nulliparas).

Conclusion Although a few fetal biometric parameters were associated with PCD, the fetal prediction model had low performance. In contrast, the maternal model had a fair-to-good ability to predict PCD.

Key Points

  • Fetal HC >90th percentile was associated with cesarean delivery.

  • Fetal parameters did not effectively predict PCD.

  • Maternal factors were more predictive of PCD.

  • Maternal/fetal and maternal models performed similarly.

  • Prediction models had lower performance in nulliparas.

Note

This study is registered with ClinicalTrials.gov (identifier: NCT00912132).


Supplementary Material



Publication History

Received: 14 May 2024

Accepted: 17 June 2024

Article published online:
29 July 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA