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The Singleton, Cephalic, Nulliparous Woman After 36 Weeks of Gestation: Contribution to Overall Cesarean Delivery Rates

Brennan, Donal J. MB, PhD; Murphy, Martina RGN; Robson, Michael S. MRCOG; O'Herlihy, Colm MD

doi: 10.1097/AOG.0b013e318204521a
Original Research

OBJECTIVE: To examine the contribution of singleton, cephalic, term (37 weeks or later) nulliparous cesarean rates to overall cesarean incidence in a single institution during a 35-year period.

METHODS: Cesarean rates were examined for 1974, 1984, 1994, 1999, 2005, and 2008, applying a 10-group classification system. Groups 1 (spontaneously laboring, term nulliparous women) and 2 (prelabor cesarean and induced term nulliparous women) were combined as a composite variable—the term, singleton, cephalic nulliparous woman.

RESULTS: Overall and term, singleton, cephalic nulliparous cesarean rates correlated throughout the 35-year period (r=0.93, P<.001). Between 1974 and 2008, overall cesarean rates increased from 5% to 19.1% and from 4.4% to 15.8% among term, singleton, cephalic nulliparous women. Term, singleton, cephalic nulliparous inductions increased from 19.7% to 32.7% (P<.001) and the intrapartum cesarean rate in term, singleton, cephalic nulliparous inductions rose from 4.1% to 27.3%. The cesarean rate in group 1 increased from 2.3% to 7.2%.

CONCLUSION: The increase in term, singleton, cephalic nulliparous cesarean rates correlated with the increase in overall cesarean rates throughout 35 years in an institution with standard management of labor. This relationship was due to an increase in both the incidence and rate of cesarean delivery within term, singleton, cephalic nulliparous inductions. Examination of the different term, singleton, cephalic nullipara components (spontaneous labor, induction, or prelabor cesarean) can help to identify major variations in practice between institutions.


Nulliparous women carrying singleton cephalic term pregnancies contribute significantly to overall cesarean delivery rates.

From the National Maternity Hospital, Dublin, Ireland; and the University College Dublin School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland.

Presented at the Society for Maternal-Fetal Medicine 30th Annual Scientific Meeting, February 1–6, 2010, Chicago, Illinois.

Corresponding author: Michael Robson, National Maternity Hospital, Dublin 2, Ireland; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.