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
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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.
