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Temporal trends of cesarean delivery on maternal request in the United States, 2016–2019

  • Author Footnotes
    1 Contributed equally to this study.
    Ariane C. Youssefzadeh
    Footnotes
    1 Contributed equally to this study.
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
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  • Rachel S. Mandelbaum
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA

    Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
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  • Kelly M. Donovan
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
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  • Caroline J. Violette
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
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  • Alexandra M. McGough
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA

    Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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  • Maximilian Klar
    Affiliations
    Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany
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  • Joseph G. Ouzounian
    Affiliations
    Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
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  • Author Footnotes
    1 Contributed equally to this study.
    Koji Matsuo
    Correspondence
    Corresponding author at: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA 90033, USA.
    Footnotes
    1 Contributed equally to this study.
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA

    Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
    Search for articles by this author
  • Author Footnotes
    1 Contributed equally to this study.
Published:October 06, 2022DOI:https://doi.org/10.1016/j.ejogrb.2022.10.002

      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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