Abstract
Objective
Cesarean delivery on maternal request (elective-CD) increased between 1999 and 2015
in the United States, but multiple studies have reported the association between elective-CD
and adverse maternal and neonatal outcomes. More contemporary trends and outcomes
are currently unknown. The objective of the current study was to examine contemporaneous
trends and outcomes of patients who had elective-CD in the United States.
Methods
This is a retrospective cohort study querying the Healthcare Cost and Utilization
Project’s National Inpatient Sample from January 2016 to December 2019. A three-step
exclusion approach was used to identify the surrogate for elective-CD (prior uterine
scar, maternal / fetal indications for CD, and labor). The primary outcome was temporal
trend of elective-CD. The secondary outcomes included severe maternal morbidity in
low-risk vaginal delivery candidates, assessed with inverse probability of treatment
weighting propensity score.
Results
Among 14,648,135 all deliveries for national estimates, 184,945 (1.26 %) patients
had elective-CD. The number of patients undergoing elective-CD decreased from 1.35 %
to 1.13 % among all deliveries (16.3 % relative-decrease; P-trend < 0.001) and from 4.14 % to 3.51 % among all CD cases (15.2 % relative-decrease,
P-trend = 0.002) between QT1/2016 and QT4/2019. The decreasing trend of elective-CD remained
independent in multivariable analysis: odds ratio (OR) compared to 2016, 0.96 (95 %
confidence interval [CI] 0.95–0.97) for 2017, 0.94 (95 %CI 0.93–0.95) for 2018, and
0.87 (95 %CI 0.86–0.89) for 2019. In a propensity score weighted model among low-risk
vaginal delivery candidates, patients in the elective-CD group were more likely to
have severe maternal morbidity compared to those in the non-elective-CD group (OR
2.01, 95 %CI 1.87–2.15).
Conclusions
This national-level analysis suggests that the number of elective-CD is gradually
decreasing in recent years in the United States.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
ACOG Committee Opinion No. 761: Cesarean Delivery on Maternal Request. Obstet Gynecol 2019;133(1): e73-e77.
- Reasons for elective cesarean section on maternal request: a systematic review.J Matern Fetal Neonatal Med. 2020; 33: 3867-3872
- Indications contributing to the increasing cesarean delivery rate.Obstet Gynecol. 2011; 118: 29-38
- Cesarean Delivery on Maternal Request in the United States from 1999 to 2015.Am J Obstet Gynecol. 2021;
CMQCC. https://www.cmqcc.org/focus-areas/quality-improvement/ntsv-c-sections. Accessed March 11 2022.
- Is there a useful cesarean birth measure? Assessment of the nulliparous term singleton vertex cesarean birth rate as a tool for obstetric quality improvement.Am J Obstet Gynecol. 2006; 194 (discussion 1651–1642): 1644-1651
- Elective Cesarean Section on Term Pregnancies Has a High Risk for Neonatal Respiratory Morbidity in Developed Countries: A Systematic Review and Meta-Analysis.Front Pediatr. 2020; 8: 286
- Diabetes prevalence and risk factors of early-onset adult diabetes: results from the Indonesian family life survey.Glob Health Action. 2021; 14: 2001144
- Cesarean section and the risk of emergency peripartum hysterectomy in high-income countries: a systematic review.Arch Gynecol Obstet. 2015; 292: 1201-1215
- Placenta accreta spectrum: accreta, increta, and percreta.Obstet Gynecol Clin North Am. 2015; 42: 381-402
- Birth outcomes following cesarean delivery on maternal request: a population-based cohort study.CMAJ. 2021; 193: E634-E644
- Maternal short-term complications after planned cesarean delivery without medical indication: A registry-based study.Acta Obstet Gynecol Scand. 2019; 98: 905-912
- Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term.CMAJ. 2007; 176: 455-460
HCUP. https://www.hcup-us.ahrq.gov/nisoverview.jsp. Published 2021. Accessed 08/01/2021 2021.
- Racial and Ethnic Disparities in Death Associated With Severe Maternal Morbidity in the United States: Failure to Rescue.Obstet Gynecol. 2021; 137: 791-800
- Trends, characteristics, and outcomes of placenta accreta spectrum: a national study in the United States.Am J Obstet Gynecol. 2021;
- Society for Maternal-Fetal Medicine Health Policy C: Comparing variation in hospital rates of cesarean delivery among low-risk women using 3 different measures.Am J Obstet Gynecol. 2016; 214: 153-163
Armstrong J, McDermott P, Saade GR, Srinivas SK, Society for Maternal-Fetal Medicine Health P, Advocacy C, et al.: Coding update of the SMFM definition of low risk for cesarean delivery from ICD-9-CM to ICD-10-CM. Am J Obstet Gynecol 2017;217(1): B2-B12 e56.
Soni A, Fingar K, Reid L. www.hcup-us.ahrq.gov/reports/statbriefs/sb254-Delivery-Hospitalizations-Substance-Use-Clinical-Outcomes-2016.pdf. Published 2019. Accessed 8/1/2021 2021.
ACOG, SMFM, Caughey AB, Cahill AG, Guise JM, Rouse DJ: Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 2014;210(3): 179-193.
CMQCC. https://www.cmqcc.org/choose-your-hospital. Accessed March 11 2022.
- Risk of Cesarean Delivery for Women with Obesity Using a Standardized Labor Induction Protocol.Am J Perinatol. 2021; 38: 1453-1458
- A decade's experience in primipara, term, singleton, vertex parturients with a sustained low rate of CD.J Perinat Med. 2019; 48: 27-33
- Myometrial oxytocin receptor expression and intracellular pathways.Minerva Ginecol. 2014; 66: 267-280
- Regulation of 15-hydroxyprostaglandin dehydrogenase (PGDH) gene activity, messenger ribonucleic acid processing, and protein abundance in the human chorion in late gestation and labor.J Clin Endocrinol Metab. 2004; 89: 5639-5648
Article info
Publication history
Published online: October 06, 2022
Accepted:
October 1,
2022
Received:
June 6,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
