Factors affecting failed trial of labor and countermeasures: A retrospective analysis

Table 1 General data analysis of the two groups (mean ± SD, n = 9240)

Group	Cases	Age (yr)	Gestational age (d)	Gravidity (times)	Neonatal weight (g)
Observation	1076	29.33 ± 3.04	279.85 ± 7.01	1.43 ± 0.74	3329.73 ± 324.57
Control	8164	29.13 ± 3.45	277.59 ± 7.18	1.58 ± 0.88	3651.35 ± 337.62
t		1.847	9.727	-5.63	7.63

Table 2 Comparison of basic data and labor management between the two groups

	Pregnancy outcome				χ2	P value
	Control group (vaginal delivery)		Observation group (conversion to cesarean section)
	Frequency	Percent	Frequency	Percent
Age (yr)
≤ 20	34	0.4	3	0.3	0.503	0.478
20-35	7523	92.2	1015	94.3
≥ 35	607	7.4	58	5.4	6.005	0.014
Neonatal weight (g)
< 2500	37	0.4	6	0.6	0.381	0.537
2500-4000	7444	91.2	920	85.5
≥ 4000	683	8.4	150	13.9	36.186	0.000
Gestational age (wk)
< 37	54	0.7	5	0.6	0.303	0.582
37-41	7298	89.4	874	88.2
≥ 41	812	9.9	197	11.5	67.943	0.000
Use of uterine contraction drugs
Yes	2578	31.6	447	44.3	42.873	0. 000
No	5586	68.4	559	55.7
Parity
Primipara	6642	81.4	1040	96.7	158.695	0. 000
Multipara	1522	18.6	36	3.3
Fever during labor
Yes	365	4.5	191	17.8	296.479	0. 000
No	7799	95.5	885	82.2
Labor analgesia
Yes	3685	45.1	415	38.6	16.617	0. 000
No	4479	54.9	661	61.4
Scarred uterus
Yes	23	0.3	5	0.5	1.053	0.305
No	8141	99.7	1071	99.5
Abnormal amniotic fluid (meconium stained or bloody)
Yes	2158	26.4	290	27	0.131	0.717
No	6006	73.6	786	73
Prolonged labor/active stage retention
Yes	344	4.2	56	5.2	2.254	0.133
No	7820	95.8	1020	94.8
Prolonged pregnancy
Yes	7	0.1	1	0.1	0.006	0.94
No	8157	99.9	1075	99.9

Table 3 Multivariate logistic regression analysis of conversion to cesarean section in failed trial of labor

Factor	β	SE	Wald	P value	OR	95%CI
						Lower limit	Upper limit
Age	-0.274	0.148	3.413	0.065	0.760	0.569	1.017
Gestational age	-0.619	0.090	47.055	0.000	0.538	0.451	0.642
Primipara	-2.036	0.179	129.417	0.000	0.131	0.092	0.185
Uterine contraction drugs	-0.324	0.070	21.557	0.000	0.723	0.631	0.829
Fever during birth	-1.426	0.100	203.684	0.000	0.240	0.198	0.292
Neonatal weight	-0.282	0.052	29.809	0.000	0.754	0.681	0.834
Labor analgesia	0.620	0.070	77.782	0.000	1.858	1.619	2.132

Table 4 Analysis of indications for conversion to cesarean section in failed trial of labor

Indication for conversion to cesarean section	Frequency	Constituent ratio (%)	Ordinal position
Fetal distress	477	44.3	1
Social factors	138	12.8	2
Malpresentation	101	9.4	3
Cephalopelvic disproportion	96	8.9	4
Prolonged labor/active stage retention	56	5.2	5
Chorioamnionitis	51	4.7	6
Macrosomia	48	4.5	7
Fever during labor	20	1.9	8
Placental abruption	16	1.5	9
Pregnancy complication	15	1.4	10
Oligohydramnios	14	1.3	11
Other	14	1.3	11
Premature rupture of membranes	10	0.9	12
Umbilical abnormality	10	0.9	12
Induction failure	5	0.5	13
Scarred uterus	5	0.5	13

Table 5 Analysis of indications for conversion to cesarean section in women with high risk factors for vaginal trial of labor failure, n (%)

	Advanced age (n = 58)	Gestational wk ≥ 41 (n = 197)	Primipara (n = 1040)	Uterine contraction drugs (n = 477)	Fever during labor (n = 191)	Macrosomia (n = 150)
Fetal distress	25 (43.1)	47 (23.9)	349 (33.5)	156 (32.7)	42 (22)	37 (24.7)
Social factors	4 (6.9)	22 (11.2)	131 (12.6)	59 (12.4)	13 (6.8)	14 (9.3)
Malpresentation	7 (12.1)	10 (5.1)	78 (7.5)	55 (11.5)	18 (9.4)	12 (8)
Cephalopelvic disproportion	6 (10.3)	9 (4.6)	95 (9.1)	44 (9.2)	21 (11)	16 (10.7)
Abnormal labor	4 (6.9)	13 (6.6)	39 (3.8)	27 (5.7)	10 (5.2)	8 (5.3)
Other	12 (20.7)	96 (48.8)	348 (33.5)	136 (28.5)	87 (45.6)	63 (42)