Abstract：
OBJECTIVE: This study aimed to examine maternal and neonatal factors in cesarean deliveries due to dystocia, including cephalopelvic disproportion, latent-phase prolongation, and fetal malposition or malpresentation. Additionally, we sought to compare the differences between the dystocia subgroups.
METHODS: This retrospective case-control study included women who delivered between January 2010 and June 2021 after 37 weeks of pregnancy and underwent abdominal-pelvic CT scans within 5 years before and after delivery. Neonatal factors were extracted from medical charts immediately after delivery.
RESULTS: Among the 292 women studied, those with cesarean deliveries for dystocia were older (mean ± SD, 34.2 ± 4.27 vs. 32.2 ± 3.8, p-value = 0.002), had higher pre-pregnancy BMI (22.7 ± 3.67 vs. 21.4 ± 3.48, p-value = 0.012) and term-BMI (27.4 ± 3.72 vs. 25.9 ± 3.66, p-value = 0.010), shorter interspinous distance (ISD, the distance between ischial spine) (10.8 ± 0.76 vs. 11.2 ± 0.85 cm, p-value = 0.003), and longer head circumference (HC) (35 ± 1.47 vs. 34.4 ± 1.36 cm, p-value = 0.003) compared to those who had vaginal deliveries. Univariate logistic regression for dystocia revealed associations between HC/maternal height and HC/ISD ratios (OR, 2.02 [95% confidence interval, CI, 1.4 ~ 2.92], 12.13 [3.2 ~ 46.04], respectively). Multivariate logistic analysis indicated that maternal age, ISD, and HC were significant factors for dystocia (OR, 1.11 [95% CI, 1.01 ~ 1.21], 0.49 [0.26 ~ 0.91], 1.53 [1.07 ~ 2.19], respectively). The subgroup with latent-phase prolongation exhibited the lowest birthweight/term-BMI ratio (124 ± 18.8 vs. 113 ± 10.3 vs. 134 ± 19.1, p-value = 0.013).
CONCLUSIONS: The HC/ISD ratio emerged as a crucial predictor of dystocia, suggesting that reducing term-BMI could potentially mitigate latent-phase prolongation. Further research assessing the maternal mid-pelvis during pregnancy and labor is warranted, along with efforts to reduce BMI during pregnancy.
METHODS: This retrospective case-control study included women who delivered between January 2010 and June 2021 after 37 weeks of pregnancy and underwent abdominal-pelvic CT scans within 5 years before and after delivery. Neonatal factors were extracted from medical charts immediately after delivery.
RESULTS: Among the 292 women studied, those with cesarean deliveries for dystocia were older (mean ± SD, 34.2 ± 4.27 vs. 32.2 ± 3.8, p-value = 0.002), had higher pre-pregnancy BMI (22.7 ± 3.67 vs. 21.4 ± 3.48, p-value = 0.012) and term-BMI (27.4 ± 3.72 vs. 25.9 ± 3.66, p-value = 0.010), shorter interspinous distance (ISD, the distance between ischial spine) (10.8 ± 0.76 vs. 11.2 ± 0.85 cm, p-value = 0.003), and longer head circumference (HC) (35 ± 1.47 vs. 34.4 ± 1.36 cm, p-value = 0.003) compared to those who had vaginal deliveries. Univariate logistic regression for dystocia revealed associations between HC/maternal height and HC/ISD ratios (OR, 2.02 [95% confidence interval, CI, 1.4 ~ 2.92], 12.13 [3.2 ~ 46.04], respectively). Multivariate logistic analysis indicated that maternal age, ISD, and HC were significant factors for dystocia (OR, 1.11 [95% CI, 1.01 ~ 1.21], 0.49 [0.26 ~ 0.91], 1.53 [1.07 ~ 2.19], respectively). The subgroup with latent-phase prolongation exhibited the lowest birthweight/term-BMI ratio (124 ± 18.8 vs. 113 ± 10.3 vs. 134 ± 19.1, p-value = 0.013).
CONCLUSIONS: The HC/ISD ratio emerged as a crucial predictor of dystocia, suggesting that reducing term-BMI could potentially mitigate latent-phase prolongation. Further research assessing the maternal mid-pelvis during pregnancy and labor is warranted, along with efforts to reduce BMI during pregnancy.
摘要：
目的：本研究旨在探讨难产剖宫产的母婴因素，包括头盆比例失调,潜伏期延长，和胎儿错位或畸形。此外,我们试图比较难产亚组之间的差异.
方法：这项回顾性病例对照研究纳入了2010年1月至2021年6月在妊娠37周后分娩并在分娩前后5年内进行腹盆腔CT扫描的妇女。分娩后立即从医学图表中提取新生儿因素。
结果：在研究的292名女性中，剖宫产难产者年龄较大(平均值±SD，34.2±4.27vs.32.2±3.8，p值=0.002），孕前BMI较高（22.7±3.67vs.21.4±3.48，p值=0.012）和足月BMI（27.4±3.72vs.25.9±3.66，p值=0.010），较短的棘突间距离(ISD，坐骨脊柱之间的距离)(10.8±0.76vs.11.2±0.85cm,p值=0.003)，和较长的头围（HC）（35±1.47vs.34.4±1.36cm,与阴道分娩的人相比，p值=0.003）。难产的单因素逻辑回归显示HC/孕妇身高和HC/ISD比率之间存在关联（OR，2.02[95%置信区间，CI，1.4~2.92]，12.13[3.2~46.04],分别)。多因素Logistic分析显示,产妇年龄,ISD,和HC是难产的重要因素(OR，1.11[95%CI，1.01~1.21]，0.49[0.26~0.91]，1.53[1.07~2.19]，分别)。潜伏期延长的亚组表现出最低的出生体重/足月BMI比率（124±18.8vs.113±10.3vs.134±19.1，p值=0.013）。
结论：HC/ISD比值是难产的重要预测指标，提示降低term-BMI有可能减轻潜伏期延长.进一步的研究评估孕妇在怀孕和分娩期间的骨盆中部是必要的，同时努力降低怀孕期间的BMI。
方法：这项回顾性病例对照研究纳入了2010年1月至2021年6月在妊娠37周后分娩并在分娩前后5年内进行腹盆腔CT扫描的妇女。分娩后立即从医学图表中提取新生儿因素。
结果：在研究的292名女性中，剖宫产难产者年龄较大(平均值±SD，34.2±4.27vs.32.2±3.8，p值=0.002），孕前BMI较高（22.7±3.67vs.21.4±3.48，p值=0.012）和足月BMI（27.4±3.72vs.25.9±3.66，p值=0.010），较短的棘突间距离(ISD，坐骨脊柱之间的距离)(10.8±0.76vs.11.2±0.85cm,p值=0.003)，和较长的头围（HC）（35±1.47vs.34.4±1.36cm,与阴道分娩的人相比，p值=0.003）。难产的单因素逻辑回归显示HC/孕妇身高和HC/ISD比率之间存在关联（OR，2.02[95%置信区间，CI，1.4~2.92]，12.13[3.2~46.04],分别)。多因素Logistic分析显示,产妇年龄,ISD,和HC是难产的重要因素(OR，1.11[95%CI，1.01~1.21]，0.49[0.26~0.91]，1.53[1.07~2.19]，分别)。潜伏期延长的亚组表现出最低的出生体重/足月BMI比率（124±18.8vs.113±10.3vs.134±19.1，p值=0.013）。
结论：HC/ISD比值是难产的重要预测指标，提示降低term-BMI有可能减轻潜伏期延长.进一步的研究评估孕妇在怀孕和分娩期间的骨盆中部是必要的，同时努力降低怀孕期间的BMI。
