Emergency cesarean sections can be predicted by markers for stress, worry and sleep disturbances in first-time mothers

Abstract

Objective: To identify predictors as free-text markers for mental ill-health from an electronic perinatal record (EMR) system and the association with emergency cesarean section (CS) in nulliparous women.

Material and methods: This was a population-based study using an EMR system, set in the catchment area of Malmö University Hospital in Sweden. Of 10,662 nulliparous women presenting with a singleton cephalic baby for vaginal delivery between 2001 and 2006, 6,467 women with complete EMRs were selected. A free-text search of markers for mental ill-health was carried out, and results were analysed by multivariate logistic regression. Eleven markers for mental ill-health were tested with Cohen's kappa for agreement and used as exposure variables. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for emergency CS, and adjusted for maternal age, diabetes, epidural anesthesia and gestational weeks <37 and >41 by a multivariate logistic regression model with vaginal delivery as the reference.

Results: Three markers identified from the EMR system reached statistically significant associations with an increased risk for emergency CS in nulliparous women: stress, adjusted OR 1.66 (95% CI 1.34-2.06); sleep, adjusted OR 1.57 (95% CI 1.14-2.16); and worry, adjusted OR 1.41 (95% CI 1.10-1.79).

Conclusion: Free-text words in medical records that indicated stress, sleep disturbances or worry predicted increased adjusted OR for emergency CS in first-time mothers. Recognizing pregnant women's reporting of their mental health status could have a predictive bearing on delivery outcomes.