Establishment of factors contributing to completion of labor by caesarean section

One of the urgent problems in obstetric practice is the disclosure of pathogenetic mechanisms of violation of the contractile activity of the uterus during childbirth, which is accompanied by an increase in the risk of emergency caesarean section. Among the reasons, a significant role is assigned to anomalies of labor activity (10–25 %), in which labor activity is inhibited for unknown reasons. The appointment of drugs that stimulate the contractile function of the uterus during childbirth, with a mechanical obstruction not diagnosed in a timely manner, is accompanied by an increased risk of fetal asphyxia, birth trauma and leads to a belated caesarean section. Timely prediction of the course of the birth process and the selection of pregnant women for controlled delivery are one of the main medical problems. In view of the foregoing, we have established factors that are directly related to the formation of the cause of an emergency caesarean section. A retrospective study was conducted based on the analysis of medical documentation (history of childbirth) of 99 puerperas hospitalized in the 3rd City Clinical Hospital named after E. V. Klumov» in Minsk in 2021–2022. The main group consisted of 52 women after spontaneous childbirth (the average age of the patients was 26.7 ± 3.6). 49 puerperas of the comparison group were examined after emergency operative delivery (the average age of the patients was 27.6 ± 2.5). All puerperas of the compared groups were prescribed oxytocin infusions during labor in accordance with the clinical protocol. According to the results of our research, most of the signs that contribute to the completion of labor by caesarean section are related to mechanical difficulties. Undoubtedly significant predictors of the completion of labor by caesarean section were: acute fetal hypoxia, chronic decompensation according to cardiotocography and incorrect insertion of the fetal head. The most significant predictors were a decrease in contractile activity (OR = 21.0, CI 11.68–37.09, p < 0.001), cervical dystocia (OR = 10.0, CI 2.41–18.90, p < 0.001) and discoordination of labor according (OR = 6.0, CI 1.6–17.9, p = 0.006), the presence of which increases the chances of operative delivery by 21.0; 10.0 and 6.0 times, respectively. Weakness of labor activity and uterine atony in labor are a fairly common cause of emergency caesarean section due to the lack of effect of the therapy or violation of the fetal condition, but the mechanisms of their formation remain unidentified.

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