Short stature - An independent risk factor for Cesarean delivery

Objective: The present study was aimed to investigate pregnancy outcome of patients with short stature (height < 155 cm), and specifically to elucidate if patients with short stature are at an increased risk for Cesarean section (CS) even after controlling for labor dystocia. Methods: A population-based study comparing pregnancy outcome of patients with and without short stature, was performed. Deliveries occurred during the years 1988-2002, in a tertiary medical center. Stratified analyses, using the Mantel-Haenszel technique, and a multiple logistic regression model were performed to control for confounders. Results: During the study period, 159,210 deliveries occurred. Of these, 5822 (3.65%) were of patients with short stature. Patients with short stature had statistically significant higher rates of CS compared with patients ≥155 cm (21.3% versus 11.9%, odds ratio (OR) = 2.0; 95% confidence interval (CI): 1.9-2.1; P < 0.001). Furthermore, there patients had higher rated of previous deliveries by CS (17.5% versus 10.3%, OR = 1.8; 95% CI: 1.7-2.0; P < 0.001), intrauterine growth restriction (IUGR, 3.2% versus 1.9%, OR = 1.7; 95% CI: 1.4-1.9; P < 0.001), premature rupture of membranes (PROM, 7.1% versus 5.6%, OR = 1.3; 95% CI: 1.2-1.4; P < 0.001), failed induction (0.7% versus 0.4%, OR = 2.0; 95% CI: 1.5-2.8; P < 0.001), labor dystocia (6.1% versus 3.5%, OR = 1.8; 95% CI: 1.6-2.0; P < 0.001), mal-presentations (7.6% versus 6.1%, OR = 1.3; 95% CI: 1.1-1.4; P < 0.001), and cephalopelvic disproportion (CPD, 0.9% versus 0.3%, OR = 2.6; 95% CI: 1.9-3.4; P < 0.001). No significant differences were noted between the groups regarding perinatal complications such as low birth-weight, meconium-stained amniotic fluid, perinatal mortality, and low Apgar scores at 5 min. Controlling for possible confounders such as previous CS, IUGR, PROM, failed induction, labor dystocia, mal-presentations and CPD, using the Mantel-Haenszel technique, did not change the significant association between short stature and CS. Moreover, a multiple logistic regression model was constructed with CS as the outcome variable, controlling for all these confounders. The model found short stature to be an independent risk factor for CS (OR = 1.7; 95% CI: 1.6-1.9; P < 0.001). Conclusion: Short stature is an independent risk factor for Cesarean delivery. Further studies investigating the actual indication for CS should be performed in order to make an informed recommendation regarding the preferred mode of delivery in short parturient women.