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Labour and Delivery Posters
Can we predict the risk of caesarean section in induction of labour (IOL) for postdates in nulliparous women?
  1. S Mittal1,
  2. A Yulia2,
  3. P Ayuk3
  1. 1University Hospital of North Durham, Durham, United Kingdom
  2. 2Cumbria NHS Foundation Trust, Penrith, United Kingdom
  3. 3Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom


Background Nulliparous women undergoing induction of labour (IOL) have a high risk of caesarean section. To date, cervical assessment is the only clinical parameter that is used to assess this risk.

Aim To develop a clinical tool that could be used to assess risk of caesarean section in women having IOL.

Methods 605 women in Group A with IOL at term (April 2009 - March 2010) and 402 women in Group B undergoing IOL for post-dates (April 2010 – March 2011) were included. ROC curve analysis using group A identified Bishop score ≤ 3 and pre-induction base-line fetal heart rate ≥ 141 bpm as being predictive of caesarean section. A composite score was developed with Bishop score (≤ 3= 1, >3 = 0) and baseline fetal heart rate (≥ 141= 1, < 141 = 0).

Results Nulliparous with post-dates induction (Group A, n = 152) had 28.8%, 38.5% and 70% risk for caesarean section for composite scores 0, 1 and 2 respectively (p = 0.001). The risk of caesarean section in nulliparous women in group B was 23.1%, 36.7% and 48.2% for scores 0, 1 and 2 respectively (p < 0.05). The scoring system was not discriminatory in multiparous women or other term IOL.

Conclusion A composite scoring system identified nulliparous post-dates women with a low, moderate and high risk of caesarean section. However, the system is not sufficiently discriminatory for clinical use.

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