Cesarean Delivery in Adolescents

Abstract

Rates of cesarean delivery among low risk women of all ages have risen markedly over the past two decades, and adolescents are not immune to this trend. In subsequent pregnancies, nearly 90% of these women will deliver by repeat cesarean, which carries significant risks of maternal and infant morbidity and mortality secondary to adhesive disease, abnormal placentation and uterine rupture. To date, understanding of risk factors for cesarean delivery in adolescents is limited, and we therefore sought to examine how adolescent maternal age affects indication for primary cesarean delivery in a cohort of nulliparous women delivering vertex presenting singletons at term. This was a retrospective cohort study in an urban academic tertiary care center evaluating age related risk factors for, and characteristics of, mode of delivery for nulliparous women delivering vertex-presenting singletons at term. Adolescents were half as likely to undergo cesarean delivery overall (OR=0.48; 95%CI 0.43, 0.54), and more than one third less likely to undergo cesarean delivery in labor (OR=0.59; 95%CI 0.53, 0.66). Adjustment for potential confounders did not alter the strength of these associations. Adolescents were half as likely to undergo cesarean delivery for failure to progress (OR=0.49, 95%CI 0.43-0.54). There was no difference in the odds of cesarean delivery for non-reassuring fetal status (OR=0.91, 95%CI 0.77-1.06), nor genital herpes (OR=1.44, 95%CI 0.57-3.68). Induction, macrosomia, oxytocin augmentation and any labor complication were all associated with increased risk of cesarean delivery. There was no difference in the duration of second stage for adolescents who delivered by cesarean delivery compared with adults (240.0 vs. 237.7 minutes, p=0.84), but those adolescents who delivered vaginally had a second stage that was one third shorter than adults (62.5 vs 100.3 minutes, p<0.001). Adolescents are half as likely to undergo primary cesarean delivery overall, and 40% less likely to undergo a primary cesarean delivery in labor, even after adjustment for multiple maternal, neonatal and labor characteristics. This difference is not explained by differences in the duration of the second stage of labor.