Pregnancy Outcome and Predictive Factors for Adverse Pregnancy Outcomes of Cephalopelvic Disproportion Pregnancies in a Resource-Limited Setting with an Efficient Referral System
Prachratana Nuchpramool MD*, Tharangrut Hanprasertpong MD*
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Objective : Small local hospitals with inexperienced personnel 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 predictive factors for 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 232.32103.75 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 was for pregnant 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.
Keywords : Predictive factor, Cephalopelvic disproportion (CPD), Pregnancy outcome, Referral
