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Am J Perinatol
DOI: 10.1055/a-2097-1958
Original Article

Contemporary Trends in Cesarean Delivery Rates and Indications

Sara Jaber
1   Department of Obstetrics and Gynecology, Beaumont Hospital Royal Oak, Royal Oak, Michigan
,
Christina T. Blanchard
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
3   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Michelle Y. Lu
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
3   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Gabriella D. Cozzi 
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
3   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Brian M. Casey
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
3   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Alan T. Tita
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
3   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Dhong-Jin Kim
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
3   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Jeff M. Szychowski
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
4   Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
,
Akila Subramaniam
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
3   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations Funding None.
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Abstract

Objective This study aimed to describe cesarean delivery rates and indications at a single center in order to assess the impact of the guidelines published by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine on trends in labor management.

Study Design This is a retrospective cohort study of patients ≥23 weeks' gestation delivering at a single tertiary care referral center from 2013 to 2018. Demographic characteristics, mode of delivery, and main indication for cesarean delivery were ascertained by individual chart review. Cesarean delivery indications (mutually exclusive) were the following: repeat cesarean delivery, nonreassuring fetal status, malpresentation, maternal indications (e.g., placenta previa or genital herpes simplex virus), failed labor (any stage labor arrest), or other (i.e., fetal anomaly and elective). Polynomial (cubic) regression models were used to model rates of cesarean delivery and indications over time. Subgroup analyses further examined trends in nulliparous women.

Results Of the 24,637 patients delivered during the study period, 24,050 were included in the analysis; 7,835 (32.6%) had a cesarean delivery. The rates of overall cesarean delivery were significantly different over time (p < 0.001), declining to a minimum of 30.9% in 2014 and peaking at 34.6% in 2018. With regard to the overall cesarean delivery indications, there were no significant differences over time. When limited to nulliparous patients, the rates of cesarean delivery were also noted to be significantly different over time (p = 0.02) nadiring at 30% in 2015 from 35.4% in 2013 and then rising up to 33.9% in 2018. As for nulliparous patients, there was no significant difference in primary cesarean delivery indications over time except for nonreassuring fetal status (p = 0.049).

Conclusion Despite changes in labor management definitions and guidelines encouraging vaginal birth, the rates of overall cesarean delivery did not decrease over time. The indications for delivery, particularly failed labor, repeat cesarean delivery, and malpresentation have not significantly changed over time.

Key Points

  • The rates of overall cesarean deliveries did not decrease despite the 2014 published recommendations for the reduction in cesarean deliveries.

  • There were no significant differences in the indications of cesarean deliveries among nulliparous or multiparous women.

  • Despite the adoption of strategies to reduce the overall and primary cesarean delivery rates, these trends remain unchanged.

  • Indications for delivery, particularly failed labor, repeat cesarean delivery, and malpresentation have also not significantly changed over time.

  • Additional strategies to encourage and increase vaginal delivery rates must be adopted.

Keywords

contemporary trends - primary and repeat cesarean deliveries - external cephalic version - fetal malpresentation - nonreassuring fetal heart tones - labor arrest - trail of labor after cesarean

Note

Data were presented as a virtual poster presentation at the Society for Maternal-Fetal Medicine Annual meeting from January 25–30, 2021, and were published in the supplemental edition of the American Journal of Obstetrics and Gynecology 2021;224(2):S322.


Supplementary Material



Publication History

Received: 17 February 2023

Accepted: 19 May 2023

Accepted Manuscript online:
22 May 2023

Article published online:
26 June 2023

© 2023. Thieme. All rights reserved.

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