Disparate Rates of Cesarean Delivery in Term Nulliparous Women with Hypertensive Disorders of Pregnancy

Abstract

Objective To evaluate the prevalence of cesarean delivery in women with hypertensive disorders of pregnancy (HDP), and explore whether maternal, sociodemographic, or obstetric comorbidities contribute to cesarean delivery rates.

Study Design This is a retrospective cohort study of nulliparous, term, singleton, vertex women using the 2013 U.S. National Vital Statistics Report. We compared prevalence of risk factors for cesarean delivery between women with and without HDP, and then calculated probabilities of cesarean delivery after controlling for these risk factors.

Results In this cohort of 1,439,977 women, the unadjusted probability of cesarean delivery in women with HDP was 39.5 versus 26.8% in those without the diagnosis (p < 0.01). Hypertensive women had more risk factors for cesarean delivery, most notably morbid obesity (9.0 vs. 3.1%, p < 0.01), diabetes (9.9 vs. 4.4%, p < 0.01), and induction of labor (59.2 vs. 26.9%, p < 0.01). Despite this, after controlling for these risk factors, hypertensive women remained significantly more likely to undergo cesarean delivery (35.1 vs. 26.4%, p < 0.01).

Conclusion Even after controlling for multiple comorbidities, hypertension remained a significant risk factor for cesarean delivery in nulliparous women at term. Hypertensive women may therefore represent an important target population in efforts aimed at reduction of cesarean rates.

Keywords

hypertensive disorders of pregnancy - cesarean delivery - perinatal - preeclampsia

Note

The findings of this study were presented at the Society for Maternal-Fetal Medicine Annual Meeting in Dallas, TX, February 1, 2018.

• References

• 1 ACOG Committee on Practice Bulletins--Obstetrics. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Obstet Gynecol 2002; 99 (01) 159-167
• 2 Hauth JC, Ewell MG, Levine RJ. , et al; Calcium for Preeclampsia Prevention Study Group. Pregnancy outcomes in healthy nulliparas who developed hypertension. Obstet Gynecol 2000; 95 (01) 24-28
• 3 Amorim MM, Souza ASR, Katz L. Planned caesarean section versus planned vaginal birth for severe pre-eclampsia. Cochrane Database Syst Rev 2017; 10: CD009430
• 4 Levine LD, Elovitz MA, Limaye M, Sammel MD, Srinivas SK. Induction, labor length and mode of delivery: the impact on preeclampsia-related adverse maternal outcomes. J Perinatol 2016; 36 (09) 713-717
• 5 Coppage KH, Polzin WJ. Severe preeclampsia and delivery outcomes: is immediate cesarean delivery beneficial?. Am J Obstet Gynecol 2002; 186 (05) 921-923
• 6 Amorim MM, Katz L, Barros AS, Almeida TS, Souza AS, Faúndes A. Maternal outcomes according to mode of delivery in women with severe preeclampsia: a cohort study. J Matern Fetal Neonatal Med 2015; 28 (06) 654-660
• 7 Kuklina EV, Ayala C, Callaghan WM. Hypertensive disorders and severe obstetric morbidity in the United States. Obstet Gynecol 2009; 113 (06) 1299-1306
• 8 Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P. ; Canadian Hypertensive Disorders of Pregnancy Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can 2014; 36 (05) 416-441
• 9 Pacher J, Brix E, Lehner R. The mode of delivery in patients with preeclampsia at term subject to elective or emergency cesarean section. Arch Gynecol Obstet 2014; 289 (02) 263-267
• 10 Mashiloane CD, Moodley J. Induction or caesarean section for preterm pre-eclampsia?. J Obstet Gynaecol 2002; 22 (04) 353-356
• 11 Crane SS, Wojtowycz MA, Dye TD, Aubry RH, Artal R. Association between pre-pregnancy obesity and the risk of cesarean delivery. Obstet Gynecol 1997; 89 (02) 213-216
• 12 Ehrenberg HM, Durnwald CP, Catalano P, Mercer BM. The influence of obesity and diabetes on the risk of cesarean delivery. Am J Obstet Gynecol 2004; 191 (03) 969-974
• 13 Bayrampour H, Heaman M. Advanced maternal age and the risk of cesarean birth: a systematic review. Birth 2010; 37 (03) 219-226
• 14 Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health 1994; 84 (09) 1414-1420
• 15 Xenakis EM, Piper JM, Field N, Conway D, Langer O. Preeclampsia: is induction of labor more successful?. Obstet Gynecol 1997; 89 (04) 600-603
• 16 Kim LH, Cheng YW, Delaney S, Jelin AC, Caughey AB. Is preeclampsia associated with an increased risk of cesarean delivery if labor is induced?. J Matern Fetal Neonatal Med 2010; 23 (05) 383-388
• 17 Healthy People Objectives. 2020. Available at: http://www.healthypeople.gov/node/4900/data_details . Accessed December 20, 2017
• 18 Barber EL, Lundsberg LS, Belanger K, Pettker CM, Funai EF, Illuzzi JL. Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol 2011; 118 (01) 29-38
• 19 DiGiuseppe DL, Aron DC, Ranbom L, Harper DL, Rosenthal GE. Reliability of birth certificate data: a multi-hospital comparison to medical records information. Matern Child Health J 2002; 6 (03) 169-179
• 20 Roberts CL, Bell JC, Ford JB, Hadfield RM, Algert CS, Morris JM. The accuracy of reporting of the hypertensive disorders of pregnancy in population health data. Hypertens Pregnancy 2008; 27 (03) 285-297