585 Cesarean delivery rates for malpresentation by race and ethnicity

Abstract

To compare cesarean delivery rates for malpresentation in the US separated by race and ethnicity. Retrospective analysis of the Centers for Disease Control and Prevention, Natality Live Birth database (2016-2018). We calculated the rate of malpresentations in cesarean deliveries (CD) for nulliparous, term, vertex, singleton (NTSV) pregnancies separately by ethnicity and by maternal race. We included four groups: Non-Hispanic whites (NHW), non-Hispanic blacks (NHB), Hispanic whites (HW), Hispanic blacks (HB). The proportion of CD done for malpresentation in non-Hispanic was set as the reference. Results were presented as Odds Ratios (OR) with 95% confidence intervals (CI). The study included a total of 926,777 cesarean deliveries. Non-Hispanic Blacks had the highest rate of CD (31.78%) while non-Hispanic Whites had the lowest rate of CD (27.85%) (Image). Malpresentation at the time of cesarean delivery was significantly higher in whites, both Hispanic and non-Hispanic, when compared to blacks. It is important to better understand why there are such discrepancies among ethnicities and races in pregnancy outcomes and cesarean deliveries in the US. In usual CDR reports both black and white races for Hispanics of the mother are conflated. When we separated the conflated rates for black and white Hispanic pregnancies, we found for the first time that black Hispanics had a malpresentation rate for CD significantly lower than white Hispanics. By combining races for Hispanics, the understanding of outcomes of different races and ethnicities in the US is misrepresented. We recommend that to better understand discrepancies in pregnancy outcomes, patient races are not conflated with ethnicity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)