• Acta Obstet Gynecol Scand · Apr 2012

    The influence of fetal head circumference on labor outcome: a population-based register study.

    • Charlotte Elvander, Ulf Högberg, and Cecilia Ekéus.
    • Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institute, Stockholm, Sweden.
    • Acta Obstet Gynecol Scand. 2012 Apr 1; 91 (4): 470-5.

    ObjectiveTo investigate the association between postnatal head circumference and the occurrence of the three main indications for instrumental delivery, namely prolonged labor, signs of fetal distress and maternal distress. We also studied the association between postnatal fetal head circumference and the use of vacuum extraction and emergency cesarean section.DesignPopulation-based register study.SettingNationwide study in Sweden.PopulationA total of 265 456 singleton neonates born to nulliparous women at term between 1999 and 2008 in Sweden.MethodsRegister study with data from the Swedish Medical Birth Register.Main Outcome MeasuresProlonged labor, signs of fetal distress, maternal distress, use of vacuum extraction and emergency cesarean section.ResultsThe prevalence of each outcome increased gradually as the head circumference increased. Compared with women giving birth to a neonate with average size head circumference (35 cm), women giving birth to an infant with a very large head circumference (39-41 cm) had significantly higher odds of being diagnosed with prolonged labor [odds ratio (OR) 1.49, 95% confidence interval (CI) 1.33-1.67], signs of fetal distress (OR 1.73, 95% CI 1.49-2.03) and maternal distress (OR 2.40, 95% CI 1.96-2.95). The odds ratios for vacuum extraction and cesarean section were thereby elevated to 3.47 (95% CI 3.10-3.88) and 1.22 (95% CI 1.04-1.42), respectively. The attributable risk proportion percentages associated with vacuum extraction and cesarean section were 46 and 39%, respectively among the cases exposed to a head circumference of 37-41 cm.ConclusionsLarge fetal head circumference is associated with complicated labor and is etiological to a considerable proportion of assisted vaginal births and emergency cesarean sections.© 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

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