Nulliparous women with term pregnancy and cephalic presentation as a focus group to reduce Caesarean section rate in future

The rate of Caesarean section (CS) is increasing for complex reasons. In previous studies it was found that CS rate of nulliparous women with term pregnancy with spontaneous labor and fetus in cephalic position (Group 1 according to Robson classification) makes great effect on the number of CS at Riga Maternity hospital. A descriptive retrospective study was conducted in Riga Maternity hospital for the year 2019. Data about the Group 1 were collected from the electronic medical data basis, medical histories. Data were further analysed with Microsoft Excel and SPSS 26.0. In 2019 there were 5835 deliveries in Riga Maternity hospital, CS rate – 21.5%. Group 1 was 26.0% (1520 deliveries) of all deliveries with CS rate – 13.6% (207) which makes 3.5% of all deliveries. 204 CS were analysed, 3 - excluded because lack of data. The mean age of women – 29±5.1 years with mean BMI 23.5±3.7 kg/m2. Mean gestation age at the time of delivery was 40 weeks 3 days. 85/204 (41.7%) SC were performed due to dystocia and suspected fetal compromise. 26/85 (30.6%) patients reached full dilatation; oxytocin was used in 21/26 cases (80.8%). Cardiotocography subacute 15/26 (57.7%) or chronic 8/26 (30.8%) fetal distress were seen in this group more often. 59/85 (69.4%) patients did not reach a full dilatation, of which 10/59 (16.9%) did not receive oxytocin. The most common indications for a CS were uterine dystocia 42/59 (71.2%), fetal distress 10/59 (16.9%) and a cephalopelvic disproportion 4/59 (6.8%). 43/204 (21.1%) SC was performed due suspected fetal compromise. 14/204 (6.9%) previous planned CS performed urgently due to spontaneous labour, placental abruption, or umbilical cord prolapses. The strategy to reduce SC rate should be based on more active management of labour for nulliparous women, including the use of oxytocin in childbirth.