{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:01:38Z","timestamp":1777982498137,"version":"3.51.4"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004375","name":"Tel Aviv University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004375","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Gynecol Obstet"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To develop a practical risk-stratification framework for unplanned cesarean delivery (CD) among term nulliparous individuals with hypertensive disorders of pregnancy (HDP) undergoing induction of labor (IOL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective cohort study at a single tertiary care center (January 2010-March 2025) of nulliparous individuals with singleton gestations diagnosed with HDP undergoing IOL at\u2009\u2265\u200937\u2009+\u20090 weeks. We excluded multiple gestations, major fetal anomalies, planned CD, or intrauterine fetal death. We included demographic and pregnancy characteristics available prior to induction and evaluated association with unplanned CD. Stepwise backward logistic regression was used to build a model for identifying independent predictors of unplanned CD. Sensitivity, specificity, and likelihood ratios (LR) were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1,326 eligible individuals, 347 (26.2%) underwent unplanned CD. Independent predictors of CD were age\u2009&gt;\u200935 years (adjusted odds ratio [aOR] 1.97, 95% CI 1.45\u20132.66), body mass index\u2009\u2265\u200930 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      (aOR 2.07, 95% CI 1.58\u20132.70), HDP with severe features (aOR 1.71, 95% CI 1.17\u20132.49), thrombocytopenia (aOR 2.66, 95% CI 1.17\u20136.06), and need for cervical ripening (aOR 1.63, 95% CI 1.23\u20132.16). Cesarean risk increased stepwise with accumulation of risk factors: 28.4% with\u2009\u2265\u20091 factor, 36.7% with\u2009\u2265\u20092, 44.7% with\u2009\u2265\u20093, and 64.7% with\u2009\u2265\u20094. The presence of\u2009\u2265\u20094 factors yielded a positive LR of 5.17 (95% CI 1.92\u201313.99).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In term nulliparous individuals with HDP undergoing induction, approximately one in four require CD. A simple model based on five routinely available pre-induction factors enables individualized counseling and shared decision-making at the bedside.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00404-026-08445-9","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T03:22:35Z","timestamp":1777000955000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A risk-based model for unplanned cesarean delivery following induction of labor in term hypertensive nulliparas"],"prefix":"10.1007","volume":"313","author":[{"given":"Avihu","family":"Krieger","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michal","family":"Axelrod","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baha","family":"Sibai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shalom","family":"Mazaki-Tovi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michal Fishel","family":"Bartal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"8445_CR1","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.preghy.2021.09.002","volume":"26","author":"CL DeSisto","year":"2021","unstructured":"DeSisto CL, Robbins CL, Ritchey MD, Ewing AC, Ko JY, Kuklina EV (2021) Hypertension at delivery hospitalization - United States, 2016\u20132017. 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Approval was granted by the Institutional Review Board of Sheba Medical Center (Approval No. 2250\u201325-SMC, July 2025). Given the retrospective design and use of de-identified data, the requirement for informed consent was waived.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human ethics and consent to participate declaration\u2014compliance with ethical standards"}}],"article-number":"172"}}