Contributing Indications to the Rising Cesarean Delivery Rate

By Emma L. Barber, L. Lundsberg, K. Belanger, C. Pettker, E. Funai, Jessica L. Illuzzi. Obstetrics and Gynecology, 2011

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OBJECTIVE: To examine physician-documented indications for cesarean delivery in order to investigate the specific factors contributing to the increasing cesarean delivery rate. METHODS: We analyzed rates of primary and repeat cesarean delivery, including indications for the procedure, among 32,443 live births at a major academic hospital between 2003 and 2009. Time trends for each indication were modeled to estimate the absolute and cumulative annualized relative risk of cesarean by indication over time and the relative contribution of each indication to the overall increase in primary cesarean delivery rate. RESULTS: The cesarean delivery rate increased from 26% to 36.5% between 2003 and 2009; 50.0% of the increase was attributable to an increase in primary cesarean delivery. Among the documented indications, nonreassuring fetal status, arrest of dilation, multiple gestation, preeclampsia, suspected macrosomia, and maternal request increased over time, whereas arrest of descent, malpresentation, maternal-fetal indications, and other obstetric indications (eg, cord prolapse, placenta previa) did not increase. The relative contributions of each indication to the total increase in primary cesarean rate were: nonreassuring fetal status (32%), labor arrest disorders (18%), multiple gestation (16%), suspected macrosomia (10%), preeclampsia (10%), maternal request (8%), maternal-fetal conditions (5%), and other obstetric conditions (1%). CONCLUSION: Primary cesarean births accounted for 50% of the increasing cesarean rate. Among primary cesarean deliveries, more subjective indications (nonreassuring fetal status and arrest of dilation) contributed larger proportions than more objective indications (malpresentation, maternal-fetal, and obstetric conditions). LEVEL OF EVIDENCE: III

Subfields: Obstetrics and Gynecology, Pediatrics, Perinatology and Child Health, Surgery

View Paper: https://www.semanticscholar.org/paper/5502c2cb29b258f56d80fa0fecb9d5b913235bdd

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Citations in the corpus

• Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer (2016, neutral): “Rates of cesarean delivery are increasing worldwide and in some countries exceed 50% of total births 8–10 , substantially over the estimated 15% of births requiring C-section delivery to protect the health of the mother or baby 11 .”
• Preventing the First Cesarean Delivery: Summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop (2012, background): “In many centers, the number of cesarean deliveries performed for “nonreassuring fetal status” has increased more than any other indication despite the fact that the number of women classified as high risk has not increased concomitantly.(35,36) All of these factors are compounded by the belief among”