Pregnancy outcome and predictive factors for adverse pregnancy outcomes of cephalopelvic disproportion pregnancies in a resource-limited setting with an efficient referral system

Abstract

Objective: Small local hospitals with inexperiencedpersonnel often have adverse incidence that could be prevented. A good referral system could reduce this unnecessary death rate. The present study was conducted to determine the pregnancy outcomes of cephalopelvic disproportion (CPD) cases that were referred for cesarean section at a tertiary center and presented the predictivefactorsfor adverse pregnancy outcomes.

Material and method: A retrospective study that descriptively presented the adverse pregnancy outcome in referred CPD pregnancies and analyzed for predictive factor of overall adverse pregnancy outcome.

Results: One hundred ninety five referred CPD pregnancies were included in this study. The mean duration ± SD from CPD diagnosis to childbirth was 232.32±103.75 minutes. Pregnancy additional complication was found in 42/195 (21.5%) cases, but there were no maternal or neonatal mortalities. The NICU admission and postpartum hemorrhage rates were 21.5% and 12.3%, respectively. Obesity BMI was associated with an increased risk of overall adverse maternal outcomes (OR 3.12). Previously complicated pregnancy and cervical dilatation at CPD diagnosis were significant predictors for overall neonatal adverse outcomes. The highest risk wasforpregnant women who were cesarean delivered at 10 cm cervical dilatation (OR 2.84 vs. cervical dilatation ≤5 cm, p-value 0.002).

Conclusion: A referral system is one of the modalities to avoid maternal and neonatal mortality for CPD pregnant women in a resource-limited setting. We suggest that early referral before advanced progression of cervical dilatation, especially in obese pregnant women and in complicated pregnancies, may improve the pregnancy outcomes.