ArticleBMJ (Clinical research ed.)2020
Risk of complicated birth at term in nulliparous and multiparous women using routinely collected maternity data in England: cohort study.
Article in BMJ (Clinical research ed.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 3 of them syntheses that pooled it.
What it found
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
29 citing papers in PubMed, 3 syntheses or guidelines pooled it, 54 citations in OpenAlex.
- Prophylactic manual rotation of the fetal head (manual rotation alone) to reduce operative delivery and complications for mother and babies.The Cochrane database of systematic reviews · 2025Pooled it
- Pregnancy with multiple high-risk factors: a systematic review and meta-analysis.Journal of global health · 2025Pooled it
- Obstetric Characteristics and Outcomes of Gestational Carrier Pregnancies: A Systematic Review and Meta-Analysis.JAMA network open · 2024Pooled it
- Eye-masks and earplugs compared to headband in nulliparas on increasing spontaneous vaginal delivery: a randomized trial.BMC pregnancy and childbirth · 2023Trial
- Migration and Caesarean Section Birth in the United Kingdom: A Secondary Analysis of Born in Bradford Data.Birth (Berkeley, Calif.) · 2026Article
- Early versus late amniotomy during twin labor.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- Low-normal birthweight in the first pregnancy as a risk factor for small for gestational age in the second pregnancy: A matched case-control study.Pregnancy (Hoboken, N.J.) · 2026Article
- Review
- Adverse perinatal outcomes associated with macrosomia in nulliparous women: A multicenter cohort study.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- Caul birth: A retrospective cohort study on prevalence, predictors, and maternal and neonatal outcomes.European journal of midwifery · 2026Article
- Inequalities in Preterm Birth in England: A Retrospective National Cohort Study Focusing on Deprivation and Ethnicity, Using Routinely Collected Maternity Hospital Data.BJOG : an international journal of obstetrics and gynaecology · 2025Article
- Preterm delivery is a risk factor for intrapartum complications in a subsequent term delivery.BMC pregnancy and childbirth · 2025Article
- A Retrospective Analysis of the Robson Classification Implementation in a Tertiary Care Hospital in Serbia.Journal of clinical medicine · 2025Article
- Family physicians' perspectives on advising patients on an obstetric delivery location: Study from a remote community.Canadian family physician Medecin de famille canadien · 2025Article
- Increased risk of adverse maternal pregnancy outcomes among undocumented migrants in Norway.Journal of migration and health · 2025Article
- Differences in maternal and perinatal outcomes between Dutch and non-Western women in a midwife-led care setting: a retrospective cohort study.BMC pregnancy and childbirth · 2024Article
- Outcomes in term breech birth according to intended mode of delivery-A Swedish prospective single-center experience of a dedicated breech birth team.Acta obstetricia et gynecologica Scandinavica · 2024Observational
- Association between delayed cesarean section and severe maternal and adverse newborn outcomes in the Somaliland context: a cohort study in a national referral hospital.Global health action · 2023Article
- Induction of labour at 39 weeks and adverse outcomes in low-risk pregnancies according to ethnicity, socioeconomic deprivation, and parity: A national cohort study in England.PLoS medicine · 2023Article
- Robson classification of caesarean births: implications for reducing caesarean section rate in a private tertiary hospital in Nigeria.BMC pregnancy and childbirth · 2023Article
Corrections and comments
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Authors and funding
9 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo determine the rate of complicated birth at term in women classified at low risk according to the National Institute for Health and Care Excellence guideline for intrapartum care (no pre-existing medical conditions, important obstetric history, or complications during pregnancy) and to assess if the risk classification can be improved by considering parity and the number of risk factors.
designCohort study using linked electronic maternity records.
participants276 766 women with a singleton birth at term after a trial of labour in 87 NHS hospital trusts in England between April 2015 and March 2016.
main outcome measureA composite outcome of complicated birth, defined as a birth with use of an instrument, caesarean delivery, anal sphincter injury, postpartum haemorrhage, or Apgar score of 7 or less at five minutes.
resultsMultiparous women without a history of caesarean section had the lowest rates of complicated birth, varying from 8.8% (4879 of 55 426 women, 95% confidence interval 8.6% to 9.0%) in those without specific risk factors to 21.8% (613 of 2811 women, 20.2% to 23.4%) in those with three or more. The rate of complicated birth was higher in nulliparous women, with corresponding rates varying from 43.4% (25 805 of 59 413 women, 43.0% to 43.8%) to 64.3% (364 of 566 women, 60.3% to 68.3%); and highest in multiparous women with previous caesarean section, with corresponding rates varying from 42.9% (3426 of 7993 women, 41.8% to 44.0%) to 66.3% (554 of 836 women, 63.0% to 69.5%).
conclusionsNulliparous women without risk factors have substantially higher rates of complicated birth than multiparous women without a previous caesarean section even if the latter have multiple risk factors. Grouping women first according to parity and previous mode of birth, and then within these groups according to presence of specific risk factors would provide greater and more informed choice to women, better targeting of interventions, and fewer transfers during labour than according to the presence of risk factors alone.
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