Faculty, Staff and Student Publications

Publication Date

4-24-2026

Journal

Archives of Gynecology and Obstetrics

DOI

10.1007/s00404-026-08445-9

PMID

42029903

PMCID

PMC13109274

PubMedCentral® Posted Date

4-24-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Purpose: To develop a practical risk-stratification framework for unplanned cesarean delivery (CD) among term nulliparous individuals with hypertensive disorders of pregnancy (HDP) undergoing induction of labor (IOL).

Methods: This was a retrospective cohort study at a single tertiary care center (January 2010-March 2025) of nulliparous individuals with singleton gestations diagnosed with HDP undergoing IOL at ≥ 37 + 0 weeks. We excluded multiple gestations, major fetal anomalies, planned CD, or intrauterine fetal death. We included demographic and pregnancy characteristics available prior to induction and evaluated association with unplanned CD. Stepwise backward logistic regression was used to build a model for identifying independent predictors of unplanned CD. Sensitivity, specificity, and likelihood ratios (LR) were calculated.

Results: Among 1,326 eligible individuals, 347 (26.2%) underwent unplanned CD. Independent predictors of CD were age > 35 years (adjusted odds ratio [aOR] 1.97, 95% CI 1.45-2.66), body mass index ≥ 30 kg/m2 (aOR 2.07, 95% CI 1.58-2.70), HDP with severe features (aOR 1.71, 95% CI 1.17-2.49), thrombocytopenia (aOR 2.66, 95% CI 1.17-6.06), and need for cervical ripening (aOR 1.63, 95% CI 1.23-2.16). Cesarean risk increased stepwise with accumulation of risk factors: 28.4% with ≥ 1 factor, 36.7% with ≥ 2, 44.7% with ≥ 3, and 64.7% with ≥ 4. The presence of ≥ 4 factors yielded a positive LR of 5.17 (95% CI 1.92-13.99).

Conclusion: In term nulliparous individuals with HDP undergoing induction, approximately one in four require CD. A simple model based on five routinely available pre-induction factors enables individualized counseling and shared decision-making at the bedside.

Keywords

Humans, Female, Pregnancy, Labor, Induced, Adult, Retrospective Studies, Cesarean Section, Parity, Hypertension, Pregnancy-Induced, Risk Assessment, Risk Factors, Logistic Models, Hypertensive disorders of pregnancy, Prediction, Risk factors, Counseling

Published Open-Access

yes

Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.