No abstract

Objective: Sociodemographic factors such as race/ethnicity and socioeconomic status affect primary cesarean delivery rates. Language is associated with disparate healthcare outcomes, but has not been well studied in obstetrics. We examined the association between primary unscheduled cesarean delivery rate and preferred patient language. Study Design: A retrospective cohort study was conducted at an urban medical center between 1/2017 and 1/2020. Nulliparous women with early or full term gestation without obstetric or medical contraindication to vaginal delivery were included. We used multivariable linear and logistic regressions to evaluate language differences in cesarean delivery odds and indication for cesarean. Results: Of the 1314 eligible women, 76.3% of patients preferred English, 17.8% Spanish and 5.4% other languages. Overall cesarean delivery rate was 27.6%. Controlling for age, race/ethnicity, BMI, insurance, gravidity, pregnancy comorbidities, labor induction, and infant birthweight, Spanish and other-language speaking women had significantly higher odds of undergoing cesarean compared to English-speaking women (adjusted odds ratio: 1.75; 95% CI: 1.25, 2.46). Relative proportions of indications for cesarean did not differ by language group. Documented interpreter use was an effect modifier on the relationship between language preference and cesarean (odds ratio with interpreter use: 2.89, CI 1.90, 4.39). Conclusions: Primary cesarean delivery rates were significantly higher among nulliparous women who prefer languages other than English. This difference may reflect lack of communication, provider bias or discrimination, or other factors, and should be further studied. Interpreter services should be routinely utilized and documented effectively.

BACKGROUND: Tocodynamometry is a common, noninvasive tool used to measure contraction frequency; however, its utility is often limited in patients with obesity. An intrauterine pressure catheter provides a more accurate measurement of uterine contractions but requires ruptured membranes, limiting its utility during early latent labor. Electrical uterine myography has shown promise as a noninvasive contraction monitor with efficacy similar to that of the intrauterine pressure catheter; however, its efficacy has not been widely studied in the obese population. OBJECTIVE: This study aimed to validate the accuracy of electrical uterine myography by comparing it with tocodynamometry and intrauterine pressure catheters among laboring patients with obesity. STUDY DESIGN: This was a prospective observational study from February 2017 to April 2018 of patients with obesity, aged 18 years or older, who were admitted to the labor unit with viable singleton pregnancies and no contraindications for electromyography. Patients were monitored simultaneously with electrical myography and tocodynamometry or intrauterine catheter for more than 30 minutes. Two blinded obstetricians reviewed the tracings. The outcomes of interest were continuous and interpretable tracing, number of contractions, and timing and duration of contractions, interpreted as point estimates and associated 95% confidence intervals. RESULTS: A total of 110 patients were enrolled (65 tocodynamometry, 55 intrauterine catheter). Electrical myography was significantly more interpretable during a 30-minute tracing (P=.001) and detected 39% more contractions than tocodynamometry (P<.0001; 95% confidence interval, 23%−57%), whereas there was no difference in the interpretability of tracings or number of contractions between electrical myography and an intrauterine catheter (P=.16; 95% confidence interval, −0.19 to 1.19). Patients who underwent simultaneous monitoring preferred the electrical myography device over tocodynamometry. CONCLUSION: Electrical uterine myography is superior to tocodynamometry in the detection of intrapartum uterine contraction monitoring and comparable with internal contraction monitoring.