June 5th, 2020

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Clinical Variance of the Nulliparous, Term, Singleton, and Vertex-Presenting Metric
Authors:  Elliot M. Levine, M.D., Melissa Dennis, M.D., Yahaira Plata, M.D., and Stephen Locher, M.D.
  OBJECTIVE: To compare the likelihood of a cesarean delivery of pregnancies identified as nulliparous, term, singleton, and vertex-presenting (NTSV) and which can be deemed as low risk, with those NTSV pregnancies which can be considered as high risk according to some standards.

STUDY DESIGN: Data from a single institution were used to retrospectively examine the appropriate perinatal qualifiers in order to compare the ultimate delivery type that the pregnant patient underwent, and to compare results between the low-risk and high-risk patient groups.

RESULTS: Within a 7-year span of time, of the 6,146 patients who were identified as having NTSV pregnancies, there were 4,184 patients who were considered at low risk and 1,962 that were deemed at high risk of cesarean delivery, by virtue of the recognized diagnoses that were made (pregestational diabetes, gestational diabetes, chronic hypertension, pregnancy-induced hypertension, intrauterine growth restriction, oligohydramnios or polyhydramnios, maternal age >40, or placenta previa).

CONCLUSION: A statistically significant difference was found between the low-risk and high-risk NTSV patients in terms of the cesarean delivery rate for those patients. This calls into question whether the NTSV metric should represent low-risk deliveries.
Keywords:  breech presentation, cesarean section, fetal presentation, gestational diabetes, labor presentation, obstetric delivery, pregnancy outcome, repeat cesarean section, singleton pregnancy, term pregnancy, vertex
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