986 Increasing number of scheduled repeat cesarean delivery and adverse outcomes among low-risk individuals

Abstract

With each repeat cesarean delivery (CD) there is an increase in adverse outcomes, however the rate of these outcomes is inadequately evaluated in a contemporary low-risk population. We sought to investigate maternal and neonatal adverse outcomes among low risk pregnancies delivered at term by scheduled repeat cesarean deliveries. We conducted a retrospective cohort study using the U.S vital statistics datasets from 2014-2018 using the 2003 revision of birth certificates. Inclusion criteria were non-laboring, non-anomalous singletons at term (37-41 weeks gestation) undergoing scheduled repeat cesarean delivery without diabetes (pre-gestational and gestational) or hypertensive disorders of pregnancy. The primary outcome was composite maternal adverse outcome (CMAO). The secondary outcome was composite neonatal adverse outcome (CNAO). Multi-variable Poisson regression models with robust error variance were used to estimate the association with increasing number of cesarean deliveries and adverse outcomes (using adjusted relative risks [aRR] and 95% confidence intervals [CI]). Of the 19 million births during the study period, over 1.7 million (8.7%) met the inclusion criteria. Among the cohorts 65.5% had 1 prior CD, 26.0% had 2 prior CD, 6.8% with 3 prior CD and 1.7% with 4 or more prior CD. Compared with individuals with at least 1 prior cesarean delivery, 4 or more cesarean delivery the aRR of CMAO was 2.98 (2.69-3.29). The adjusted relative risk for all four components of CMAO and all five components of CNAO increased significantly with increasing number of repeat cesarean deliveries. Among non-laboring non-anomalous singletons at term (37-41 weeks gestation) undergoing scheduled repeat cesarean delivery, increasing number of repeat cesarean delivery is a significant risk factor for adverse maternal and neonatal outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)