Indications contributing to the decreasing cesarean delivery rate at an academic tertiary center

Cross, Sarah; Greenberg, Jessica; Pettker, Christian M.; Raab, Cheryl; Illuzzi, Jessica L.

doi:10.1016/j.ajogmf.2019.05.002

Cited by 9 publications

(12 citation statements)

References 21 publications

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“…This is a follow-up study at our institution that evaluated the decline in the overall cesarean rate from 2009 to 2013, attributing 74% of the decreasing cesarean delivery rate to a decrease in primary cesareans, of which labor arrest disorders contributed the most. 5 Our population consists of low- and high-risk patients with diverse demographics who are cared for by community and MFM hospitalist providers, increasing its generalizability to hospitals with similar characteristics in the region and providing a window into the potential level of adherence among provider groups at hospitals with cesarean rates in these published ranges. Following this, highlighting opportunities for targeted improvement is essential.…”

Section: Discussionmentioning

confidence: 99%

“…2,4 A follow-up study was performed at the same institution from 2009-2013. 5 During that time period, the cesarean rate decreased from 36.5% to 31.4%, with 74% of the decrease attributable to a decrease in primary cesareans. Among documented indications for primary cesarean, the largest contributor to the decrease in the primary cesarean rate was a decrease in cesarean delivery performed for labor arrest.…”

Section: Accepted Manuscriptmentioning

confidence: 93%

“…This is a follow up study at our institution that evaluated the decline in the overall cesarean rate from 2009 to 2013, attributing 74% of the decreasing cesarean delivery rate to a decrease in primary cesareans, of which labor arrest disorders contributed the most. 5 Our population consists of low and high risk patients with diverse…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Adherence to Definitions of Labor Arrest Influence on Primary Cesarean Delivery Rate

et al. 2022

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Objective: The cesarean delivery rate in the United States is 31.9%. One of the leading indications for primary cesarean delivery is labor arrest. A modern understanding of the labor curve supports more time prior to the diagnosis of labor arrest. We conducted this study to examine the impact of adherence to modern criteria for labor arrest and failed induction on rates of primary cesarean delivery and to identify predictors of meeting these criteria. Study Design: We analyzed rates of primary cesarean delivery overall and those due to arrest of dilation, arrest of descent and failed induction among the 17,877 live births at a large academic center from 2010 through 2013. Multiple logistic regression modeling identified predictors of meeting new criteria for these indications based on guidelines published by the 2012 NICHD. Results: The primary cesarean delivery rate decreased from 23.5% to 21.1% (p=0.026) from 2010 to 2013. Primary cesarean delivery for labor arrest and failed induction decreased from 8.5% to 6.7% (p=0.005) The percentage of primary cesarean deliveries meeting 2012 criteria for labor arrest increased from 18.8% to 34.9% (p=0.002), and the rate of primary cesarean delivery due to arrest of dilation decreased from 5.1% to 3.4% (p<0.0005). The percent of cases meeting 2012 criteria for arrest of descent increased from 57.8% to 71.0% (p<0.007), while primary cesarean delivery due to arrest of descent remained relatively unchanged; 3.1% to 2.6% (p=0.330). Conclusion: A decrease in the primary cesarean rate was attributable to a decrease in cesarean for arrest of dilation in the setting of a significant increase in meeting 2012 criteria for arrest of dilation. At the end of the study period, 65.2% of cesareans still did not meet criteria for arrest of dilation. Greater rates of adherence to these guidelines may yield further reductions in the cesarean rate.

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Section: Discussionmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 93%

Section: Accepted Manuscriptmentioning

confidence: 99%

See 1 more Smart Citation

Adherence to Definitions of Labor Arrest Influence on Primary Cesarean Delivery Rate

et al. 2022

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“…8 Globally, the increase in CD rates have mainly occurred in middleand high-income countries, which increasingly utilize advanced technology for continuous external fetal monitoring. 9,10 The National Institutes of Health estimate that elective CD make up about 2.5% of all births in the U.S. 11 The option of an elective CD may be contributing to rising CD rates. Traditionally, CD has been considered a form of emergency or highlevel intervention to respond to a critical or emergent maternal or fetal situation.…”

Section: Introductionmentioning

confidence: 99%

“…Private/public insurance coverage has been shown to a have peculiar distribution among different race/ethnicities and age groups amongst pregnant women. 10,13 In ideal circumstances, the type of insurance coverage a mother has should not impact the care delivered to her. An increase in utilization and cost with no improvement in outcomes represents a decline in value.…”

Section: Introductionmentioning

confidence: 99%

Variations in cesarean deliveries associated with payer type

Dunne

Sherwood

Sheth

et al. 2022

Proceedings in Obstetrics and Gynecology

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Objective: The rates of cesarean deliveries (CD) in the United States (U.S.) have been increasing since the 1990s making it the most common operating room procedure in U.S. hospitals. CD may be necessary due to a variety of medical indications; however, it is not clear whether socioeconomic factors affect CD rates. This study examines the association between type of insurance coverage pregnant women have and rates of CD in the U.S.Methods: This is a retrospective analysis of the discharge records of pregnant women admitted to U.S. hospitals between 2012 and 2014 extracted from the National Inpatient Sample dataset. The study population was divided into two groups according to insurance coverage (public vs private). Logistic regression analysis was used to examine the association between type of insurance and CD rates while controlling for an array of demographic, medical, social and behavioral confounding factors.Results: 12,450,349 subjects were included in the analysis, of those, 29.9% had a CD. 82.6% of women are between 18-34 years old and 49.5% are Caucasians. 48.9% of women have private insurance. Women with private insurance received a higher percentage of cesarean deliveries (31.8%) compared to women with public insurance (28.3%), adjusted odds ratio (aOR): 1.30 (CI: 1.29-1.30, p<0.001). This ratio was more significant in AMA women (aOR: 1.37) but not among teenagers. Although, higher in all race/ethnicity groups, African American, Hispanic and Native American women have more significant association to receive CD when covered by private insurance compared to Caucasian women. Giving birth at an urban-teaching hospital was associated with a higher CD rate (31.9% vs. 27.4%), aOR: 1.42. Delivery in the Northeast was associated with increased CD rates (32.8% vs. 27.5%) when covered with private insurance, aOR: 1.43, while in the West, private insurance was associated with less CD, aOR: 1.17.Conclusion: After controlling for demographic, clinical, behavioral, and system variables, private insurance was associated with a 30% increase in rate of CD compared to public insurance.

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A new index for obstetrics safety and quality of care: integrating cesarean delivery rates with maternal and neonatal outcomes

Ramani

Halpern

Akerman

et al. 2022

American Journal of Obstetrics and Gynecology

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Indications contributing to the decreasing cesarean delivery rate at an academic tertiary center

Cited by 9 publications

References 21 publications

Adherence to Definitions of Labor Arrest Influence on Primary Cesarean Delivery Rate

Adherence to Definitions of Labor Arrest Influence on Primary Cesarean Delivery Rate

Variations in cesarean deliveries associated with payer type

A new index for obstetrics safety and quality of care: integrating cesarean delivery rates with maternal and neonatal outcomes

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