Abstract
BackgroundIt is currently unknown whether primary CDs performed in compliance with the 2014 ACOG/SMFM Obstetric Care Consensus Statement guidelines (“guideline-compliant”) are associated with a modified risk of maternal and neonatal morbidity, when compared to primary CDs performed outside the guidelines (“guideline-noncompliant”). Our primary objective was to determine if a guideline-compliant primary CD is associated with a modified risk for maternal or neonatal morbidity, when compared to guideline-noncompliant primary CD.MethodsA retrospective cohort study of all primary CDs at one tertiary referral center in the calendar year following publication of the Consensus Statement. Logistic regression was performed to calculate the risk of adverse maternal and neonatal outcomes for guideline-compliant primary CDs, when compared to guideline-noncompliant and guideline-not addressed, and when adjusted for maternal age, BMI, hypertension, gestational age at delivery, insurance carrier, and provider practice.ResultsEight hundred twenty-seven primary CDs were included during the study period, of which 34.8, 26.0, and 39.2% were guideline compliant, guideline-noncompliant, and guideline-not addressed. No statistically significant differences in the frequency of adverse maternal outcomes across these three groups were observed with the exception of maternal ICU admission, which was significantly associated with a guideline-not addressed primary CD (p = 0.0002). No statistical difference in rates of NICU admissions, 5 min APGAR < 5, or umbilical artery cord pH < 7 were observed between guideline-compliant and guideline-noncompliant primary CDs.ConclusionWomen undergoing guideline-compliant primary CDs were not significantly more likely to experience a maternal or neonatal morbidity when compared to guideline-noncompliant primary CDs.
Highlights
It is currently unknown whether primary cesarean delivery (CD) performed in compliance with the 2014 ACOG/Society for Maternal Fetal Medicine (SMFM) Obstetric Care Consensus Statement guidelines (“guideline-compliant”) are associated with a modified risk of maternal and neonatal morbidity, when compared to primary CDs performed outside the guidelines (“guidelinenoncompliant”)
The total number of women delivering in the same time period without a history of prior CD was identified by a SoftMed query; this number was used to calculate primary CD rates
4938 women delivered without a history of prior CD, for a total institutional primary CD rate of 16.7%
Summary
It is currently unknown whether primary CDs performed in compliance with the 2014 ACOG/SMFM Obstetric Care Consensus Statement guidelines (“guideline-compliant”) are associated with a modified risk of maternal and neonatal morbidity, when compared to primary CDs performed outside the guidelines (“guidelinenoncompliant”). In 2014, both the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) issued a national call to reduce the primary CD rate, codified in the Obstetric Care Consensus Statement, “Safe Prevention of the Primary Cesarean Delivery.” [3] In this joint document, these national organizations outlined clear and specific recommendations for the management of the following, each of which are linked to a common indication for primary CD: first and second stages of labor, fetal heart rate monitoring, induction of labor, fetal malpresentation, suspected fetal macrosomia, excessive maternal weight gain, and twin gestations. Evidence suggests compliance with these recommendations in clinical practice is associated with a reduction in the primary CD rate [4]
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