Cesarean Indications Research Articles

Finding the best formulas to estimate fetal weight based on ultrasound for the Turkish population: a comparison of 24 formulas

Background: Although prenatal diagnosis of fetal weight is a very important parameter that guides the clinician, the margin of error in fetal weight is still very high. Aims: The aim of this study is to identify the most accurate sonographic formulas for fetal weight estimation in general and specific gender subgroups of the Turkish population. Method: This study is a prospective study conducted with the term 160 pregnant women who had cesarean indication and hospitalized to give birth by a cesarean section. The actual birth weight of newborn babies and the estimated fetal weights obtained with 24 formulas were compared. Additionally, the data obtained were separated according to the gender of the newborns and the most appropriate formulas for fetal gender were tried to be determined separately. Results: The lowest Root Mean Square Error (RMSE) values which are the best indicator of success to predict were obtained as 301.8 gr, 284.9 gr and 304.4 gr with the formula of Schild et al. Male for all, the formula of Schild et al. Female for male fetuses and the formula of Campbell and Wilkinfor female fetuses, respectively. Conclusion: The formulas of Schild et al. Male , Schild et al. Female, and Campbell and Wilkin were selected as the best formulas for all fetuses, male fetuses and female fetuses, respectively, for estimating fetal weights in Turkish population.

Caesarean Indications and Rates in a Tertiary Center

Caesarean Indications and Rates in a Tertiary Center

A Secondary Analysis of the LILAC Study Regarding Cesarean Birth by Maternal Request in Women Living with HIV.

Background:Latin America has the highest regional average cesarean birth rates. One potential driver is cesarean birth by maternal request (CBMR).Methods:We analyzed of a large prospective cohort study of HIV-infected women in six Latin American countries.Results:Comparisons were made between women who chose CBMR (n = 38) and women with a medical indication for cesarean (n = 683). The only variable associated with CBMR was onset of labor (AOR 0.3 [0.1,0.9], p = 0.04).Conslusion:Spontaneous labor reduced the likelihood of a woman living with HIV to pursue CBMR in a large Latin American cohort.

Comparison of maternal morbidity in Emergency and Elective Cesarean Section

Objective: We aimed to compare emergency and elective cesarean patients in our hospital in terms of epidemiological features and maternal morbidity.
 Material and Methods: We randomly retrospectively reviewed the records of 302 caesarean cases. Demographic features and indications for emergency (group 1) and elective caesarean section (C/S) (group 2) were recorded. The groups were compared in terms of indications and intraoperative and postoperative morbidity.
 Results: It was found that the mean hematocrit decrease in group 1 was not different from group 2 (5.70 ± 1.16 and 5.62 ± 0.67). When the groups are examined according to cesarean indications; In group 1 patients, fetal distress, cephalopelvic disproportion (CPD), non-progress of labor, abruptio placentae were significantly higher compared to group 2, whereas in group 2 patients the previous 1 C / S and previous 2 C / S indications were significantly higher. Intraoperative hemorrhage and bladder injury were more common in group 1 patients compared to group 2 patients. When the groups are examined according to postoperative maternal complications; In group 1 patients, transfusion, prolonged bladder catheterization, admission to intensive care unite (ICU), was significantly higher compared to group 2.
 Conclusion: It was found that many intraoperative and postoperative complications were more common in the emergency C/S group. it was also detected that all cases with bladder injuries had previous cesarean sections. Therefore, the presence of experienced personnel in these cases may be important for reducing morbidity due to the increased risk of complications.

Asymptomatic complete heart block in labor: A case report of none response to atropine therapy

Introduction: A complete heart block is a cardiac electrical conduction disorder with a very rare occurrence in pregnancy, which may be asymptomatic. There are no specific guidelines for the management of asymptomatic complete heart block in labor, vaginal delivery, and cesarean with only a few reports of cesarean management of patients with complete heart block. Case report: A 30-year-old woman, Gravida 4, abortion 3, gestational age of 41 weeks without any specific problems, was referred to our maternity hospital. The pulse rate and blood pressure were 68 and 60/110, respectively. Labor was induced with oxytocin and, after three hours, was discontinued due to late decelerations of fetal heart rate. Electrocardiography confirmed a maternal pulse rate of 42. Cardiac consultation led to the diagnosis of a complete heart block. Due to the frequent late decelerations of fetal heart rate and no response to atropine therapy, the patient was a candidate for a cesarean. Before cesarean, the pacemaker was installed. Cesarean was performed with general anesthesia, and the infant was delivered in good condition. In Postpartum, the pacemaker was removed (PR=55, BP=125/80), and the mother was discharged the next day. Due to the lack of specific guidelines, fetal indication for an emergency cesarean, mother poor obstetrics history, and none response to atropine therapy, we chose to incorporate pacemakers and remove it after cesarean safely. Conclusion: Vital signs assessment during pregnancy and childbirth is recommended to detect cases of complete heart block and provide optimal care.

Vaginal Birth after Two Previous Cesarean Sections versus Elective Repeated Cesarean: A Retrospective Study.

Trial of labor after cesarean delivery (TOLAC) is a common practice worldwide but the evidence is still scant regarding this practice in women who underwent 2 previous cesareans. The purpose of this study is to retrospectively review our experience with vaginal birth after two previous cesarean sections (VBA2C), with specific attention to the indications for previous cesarean and to the women's motivation for attempting trial of labor. This was a retrospective cohort study conducted in a primary care hospital between January 2011 and December 2019. Inclusion criteria were: singleton pregnancies, absence of morphological abnormalities at ultrasonographic screening of the second trimester (or at any other stage of pregnancy), and two previous cesarean sections. The final analysis included 114 cases for maternal and neonatal outcomes. In total, 40.4% of women chose trial of labor after two cesarean delivery (TOLA2C group). TOLA2C was associated with a success rate of 76.1%, a higher gestational age at birth, and a shorter hospital stay, compared with elective repeated cesarean delivery group. There were no significant differences in the rate of Apgar scores at 5 minutes <7 between both groups. The percentage of successful TOLA2C in women with prior vaginal delivery was 92.8%. Factors related to failed TOLA2C included failure to progress (3/11, 27.3%), nonreassuring fetal heart rate (3/11, 27.3%), and no onset of spontaneous labor after premature rupture of membranes (5/11, 45.4%). In the group of TOLA2C, more than 70% accepted to travel more than 45 minutes to reach our hospital, with the aim to attempt VBA2C. TOLA2C is a possible option for both mothers and neonates in selected cases. Adequate counseling about pros and cons of TOLA2C is mandatory. The woman's motivation represents a key element to determine the success of VBA2C. · Selection of candidates and motivation of the patients represent key elements for successful TOLA2C.. · A careful record of obstetrical history and previous deliveries can provide clinicians useful information.. · Mode of delivery in women with two previous cesareans is strongly associated with doctor's counseling..

Exploring unwarranted clinical variation: The attitudes of midwives and obstetric medical staff regarding induction of labour and planned caesarean section

BackgroundUnexplained clinical variation is a major issue in planned birth i.e. induction of labour and planned caesarean section. AimTo map attitudes and knowledge of maternity care professionals regarding indications for planned birth, and assess inter-professional (midwifery versus medical) and intra-professional variation. MethodsA custom-created survey of medical and midwifery staff at eight Sydney hospitals. Staff were asked to rate their level of agreement with 45 “evidence-based” statements regarding caesareans and inductions on a five-point Likert scale. Responses were grouped by profession, and comparisons made of inter- and intra-professional responses. FindingsTotal 275 respondents, 78% midwifery and 21% medical. Considerable inter- and intra-professional variation was noted, with midwives generally less likely to consider any of the planned birth indications “valid” compared to medical staff. Indications for induction with most variation in midwifery responses included maternal characteristics (age≥40, obesity, ethnicity) and fetal macrosomia; and for medical personnel in-vitro fertilisation, maternal request, and routine induction at 39 weeks gestation. Indications for caesarean with most variation in midwifery responses included previous lower segment caesarean section, previous shoulder dystocia, and uncomplicated breech; and for medical personnel uncomplicated dichorionic twins. Indications with most inter-professional variation were induction at 41+ weeks versus 42+ weeks and cesarean for previous lower segment caesarean section. DiscussionBoth inter- and intra-professional variation in what were considered valid indications reflected inconsistency in underlying evidence and/or guidelines. ConclusionGreater focus on interdisciplinary education and consensus, as well as on shared decision-making with women, may be helpful in resolving these tensions.

Retrospective evaluation of indications and birth results of cesarean section due to ophthalmologic diseases

Objectives: To investigate the outcomes of cesarean section due to ophthalmologic indications. Methods: This retrospective clinical study included 40,190 patients underwent cesarean section due to ophthalmological indications between January 2013 – August 2015 in MLP Care Group Hospitals (It includes 32 hospitals). Demographic data, ophthalmologic history and indications and surgical outcomes of caesarean section was assessed.Results: Of the 53 patients with caesarean delivery due to ophthalmologic indications, 32 (60.4%) had high degree myopia, 7 (13.2%) had degenerative myopia, 8 (15.1%) had history of ocular surgery, 2 (3.8%) had history of vitreoretinal surgery due to retinal detachment, 2 (3.8%) had glaucoma with uncontrolled intraocular pressure, 1 (1.9%) had retinitis pigmentosa and 1 (1.9%) had optic neuritis.Conclusions: Ratio of ophthalmic indications is small within all cesarean indications and further longitudinal studies are needed to prevent from unnecessary cesarean section.

Implementation of Venous Thromboembolism Prophylaxis After Cesarean at a High Volume Military Treatment Facility [17L

INTRODUCTION: Venous thromboembolism (VTE) is a leading cause of maternal morbidity. In 2016 the National Partnership for Maternal Safety (NPMS) published a Consensus Bundle on Venous Thromboembolism recommending postcesarean dual VTE prophylaxis for a modified Caprini score of 5 or more. The purpose of our study is to determine the impact of policy change from American College of Chest Physicians 2012 guidelines to NPMS in our facility. METHODS: Following stepwise implementation of NPMS guidelines, Caprini score calculation became mandatory after cesarean delivery. We reviewed inpatient enoxaparin prescriptions rate of postcesarean patients, comparing the 12 months before implementation with 12 months post-implementation, excluding 5 months of transition period. We also compared the rate of various adverse outcomes including blood transfusion, epidural hematoma, maternal death, wound hematoma or wound separation, re-operation, heparin induced thrombocytopenia, and venous thromboembolism. Student t-test was performed to compare average rate pre and post policy change. A P&lt;.05 was considered significant. RESULTS: The analysis included 888 cesarean deliveries pre-implementation and 1,515 post-implementation with no difference in demographics or indication for cesarean. Prior to change in policy, 3.6% (+/- 1.5% SD) of patients received dual prophylaxis. After implementation, this rose to 32.7% (+/- 6.7% SD) (P=.001). The number of cesarean deliveries with adverse outcomes up to 84 days postpartum remained stable. There was no statistically significant difference in VTE in the pre-implementation and post-implementation groups. CONCLUSION: Successful implementation of a dual VTE prophylaxis policy postcesarean delivery is possible without adversely affecting complication rates.

The Development of a Prediction Model for Vaginal Birth After Cesarean Section (VBAC) [34P

INTRODUCTION: Pregnant women who have had a previous cesarean section face the decision to either undergo a repeat elective cesarean or to attempt vaginal birth after cesarean (VBAC). The goal of this project was to determine the factors that predict success of VBAC in women with one prior cesarean section in the population of British Columbia, Canada. METHODS: Data were drawn from the British Columbia Perinatal Data Registry. We performed a retrospective analysis of 8291 cephalic term singleton planned vaginal births in British Columbia to women with a previous cesarean. Using block multivariate logistic regression, we analyzed the variables, both modifiable and non-modifiable, most predictive of successful VBAC. A result was considered statistically significant if its p value was &lt;.05. RESULTS: Of the 8291 planned VBAC births, 5960 were successful, while 2331 resulted in cesarean deliveries. Predictive variables were: maternal age, height and BMI, whether or not she had a vaginal birth within 2 years of the planned VBAC, whether she had a recurrent indication for the prior cesarean, whether she was administered oxytocin or prostaglandins for labor augmentation or induction, whether she was given an epidural, and the size of hospital in which she gave birth. CONCLUSION: A prediction model, incorporating eight variables has been developed. This model can inform shared decision-making and guide individualized counselling for eligible women on the chance of VBAC success. We hope that this prediction model will contribute to the literature and ultimately lower the probability of complications and adverse outcomes in childbirth.

Successful Myomectomy During Cesarean Section: A Case Series

Background: The incidence of myoma associated with pregnancy is reported about 0.3–5%. As the maternal age increase, so the incidence of myoma. Myomectomy is the most common surgical procedure performed during cesarean section. Many obstetricians are reluctant to perform this combined procedure as they are worried about the potential morbidity and mortality rates due to uncontrollable bleeding. Objectives of this case series is to investigate the success of myomectomy in cesarean section at Persahabatan Hospital, Jakarta. Methods: Four cases of leiomyoma with pregnancy underwent myomectomy during cesarean section. The indications for cesarean, the average surgery time, the amount of blood loss, the need of transfusion and intensive care, postoperative complications and length of stay were recorded as outcome. Results: The average time taken for surgery was about 100 minutes, average blood loss was approximately 300 ml to 1000 ml, more than usual cesarean section. There were no need of transfusion and intensive care, longer of stay or postpartum hemorrhage in any of the cases. Conclusions: Myomectomy at the time of caesarean section may be a safe and feasible procedure. Caesarean myomectomy, if done in well-equipped centers by an experienced obstetrician is a definite and safe option.

Do Anti-Factor Xa Levels have any Impact on Pregnancy Outcome in Women with Previous Adverse Outcomes?

Low-molecular-weight heparin (LMWH) is used during pregnancy in women diagnosed with thrombophilia for prevention of thromboembolic events and prevention of recurrent pregnancy loss. Prophylactic dosing does not always achieve target anti-FXa levels of 0.2-0.6 IU/ml. We aimed to determine if anti-FXa levels, measured in the first trimester, have an influence on pregnancy outcome. Eighty-one first-trimester women with a history of adverse pregnancy outcomes under LMWH therapy during pregnancy were enrolled in this study. Anti-FXa levels were measured in the first trimester, and fetal and maternal outcomes were recorded. The mean age of women was 28±4 (19-40) and mean anti-FXa level 0.44±0.93 IU/ml. No bleeding or clotting complications were associated with LMWH administration. Anti-FXa levels did not have a relationship with gestational age at birth, fetal weight, type of delivery, cesarean indications, postpartum bleeding, APGAR scores, or admission to the neonatal intensive care unit (p>0.005). Anti-FXa levels were not correlated with live birth rates. Anti-FXa levels did not have an influence on pregnancy and fetal outcomes. The effect of LMWH on pregnancy outcomes may not be due to anticoagulant activity but other mechanisms.

RISK OF NEONATAL HOSPITALIZATION ASSOCIATED TO DELIVERY BY CESAREAN SECTION IN A HIGH COMPLEXITY CLINIC IN BOGOTÁ, COLOMBIA, 2018.

To evaluate the association between cesarean delivery and hospitalization of the newborn and describe the indications for cesarean according to Robson's groups in the obstetrics service of a highly complex general institution. Cross-sectional study. All births occurred between March and July 2018 in a high complexity general teaching hospital in Bogotá, Colombia were included, by consecutive sampling up to a sample size of 1040 pregnant women. The frequency of caesarean section, indications, neonatal outcomes for each Robson group, and the risk of neonatal hospitalization are described using the crude and adjusted odds ratio (OR) using multivariate analysis. 1,493 births were included, of which 539 (36.3 %) were by cesarean section. Women with a history of uterine scar scheduled for elective caesarean section and those hospitalized for induction provide the majority of caesarean sections. The main indications for cesarean section were suspicion of unsatisfactory fetal status and prolongued labor. Adjusted for birth weight, caesarean section increased the overall risk of neonatal hospitalization (adjusted OR [aOR] = 2,2; IC 99 %: 1,3-3,7). There are groups of Robson susceptible of intervention to decrease the rate of caesarean sections due to the suspicion of unsatisfactory fetal status and prolongation of labor. An association was found between cesarean delivery and subsequent neonatal hospitalization. Randomized controlled studies are required to determine the benefit of the strategies to reduce cesarean section rates and evaluate the association found.

Condylome acumine vulvaire geant au cours de la grossesse

External anogenital condylomata acuminata associated with papillomavirus infection are common during pregnancy with a low risk of transmission during childbirth. We report a case of a giant condyloma acuminata infected during pregnancy. This was a 28-year-old primigravidae patient at 36 weeks of gestation, with no previous pathological history, who consulted for vulvar swelling with smelly leucorrhoea and tension type pain rated at 4 on the visual analogue scale. On examination, a huge mass was found on the entire vulva, not allowing individualizing the large as the small lips as well as the clitoris. The vagina was accessible and the vaginal walls were without any particularity at the vaginal touch. The speculum examination was difficult. The patient was placed under parenteral antibiotics, palliative analgesics and local care. The evolution was favorable after antibiotic treatment with a slight regression in the size of the mass. The biopsy had returned in favor of a condyloma acuminata. At 39 weeks and 4 days of gestation, the patient gave birth vaginally at home despite the indication of a scheduled cesarean. No perineal complications were found on examination and the post-partum evolution were simple. The patient was referred to dermatology with possible surgical management with plastic surgeons. Condylomatous lesions may regress spontaneously after childbirth as they may persist and require specific management. Caesarean section is not systematic but size and breech may require it.

Frequency and Indications of Lower Segment Cesarean Section in Multiparous Women with previous Normal Deliveries

Background: Cesarean section (CS) has become a frequent practice in the recent years while this increase has been seen in developing as well as developed countries. The aim of current study was to determine the frequency of lower segment cesarean section (LSCS) along with indications of LSCS in multiparous women with previous normal deliveries. Methods: This was a cross sectional study, done at the Department of Gynaecology &amp; Obstetrics, Nishtar Hospital, Multan, from 20th July 2018 to 20th January 2019. A total of 222 pregnant women with live singleton pregnancy at term with gestational age between 37 to 41weeks and multipara with no previous LSCS were included in the study. The decision to undertake LSCS if indicated was made in every case after complete assessment. Data was collected for frequency of LSCS and its indications in shape of fetal distress, antepartum hemorrhage and malpresentation. Results: Mean age was 32.720±1.96 years, mean height 1.551±0.11 meters and mean BMI was 27.855±3.14 Kg/m2. Most women were 31-35 years (90.5%) of age and 2-4 parity (89.2%). Primary caesearen section was seen in 43 patients (19.4%). Indications for primary caesarean section were malpresentation 27.9%, fetal distress 41.9% and antepartum hemorrhage 30.2%. Conclusion: The frequency of LSCS in multiparous women with previous normal deliveries was noted to be 19.4%. Fetal distress turned out to be commonest indication for primary caesarean followed by antepartum hemorrhage and malpresentation.

Outcomes of trial of labor after cesarean birth by provider type in low-risk women.

One approach to decreasing the cesarean birth rate in the United States is to increase the availability of birth attendants, including certified nurse-midwives (CNMs), who offer trial of labor after cesarean (TOLAC). We examined associations between provider type and mode of birth for women attempting vaginal birth after cesarean (VBAC). We performed a retrospective cohort study at a United States academic medical center using prospectively-collected data (2005-2012). We included healthy women with term singleton vertex pregnancies after one or two prior cesareans who were managed by obstetricians or CNMs. We assessed unplanned cesarean birth by provider type using univariate and logistic regression and examined labor interventions and predicted VBAC success. Overall VBAC success was 88% for 502 included patients. Unplanned cesarean rates were similar by provider type. Black race, no prior VBAC, recurring clinical indication for cesarean, labor augmentation/induction, and any Pitocin use were associated with increased unplanned cesarean. Higher parity and early-term gestational age at delivery were associated with decreased unplanned cesarean. Postpartum hemorrhage and composite maternal morbidity were increased with unplanned cesarean, but there was no difference in neonatal outcome by mode of delivery or provider type. Obstetricians had slightly higher composite adverse maternal outcomes. Nomogram-predicted VBAC success but not provider type was associated with unplanned cesarean. Unplanned cesarean was similar for patients attempting labor after cesarean managed by midwives or obstetricians. Increasing the number of CNMs who manage TOLAC may help decrease the high rate of cesareans.

Indications and rate of first cesarean delivery in central region's maternity and children hospital.

Objectives:To investigate the indications of first (non-repeated) cesarean deliveries, to categorize those indications into absolute and relative according to established guidelines of cesarean deliveries, and to compare the women with absolute and relative indications by demography and pregnancy-related attributes.Methods:A cross-sectional analysis of delivery data between September and October 2018, at the Maternity and Children Hospital, Buraidah, Al-Qassim, Saudi Arabia. Indications for cesarean deliveries of 200 primary cases were abstracted and were categorized into ‘absolute’ and ‘relative’ according to the Association of the Scientific Medical Societies in Germany guidelines.Results:The leading indications were fetal distress (27.5%), non-progression of labor (22.5%), breech presentation (18%), and failed initiation of labor (4.5%). Of the 200 cases, 26.5% had absolute indications, 50% had relative indications, and 23.5% had indications that were neither absolute nor relative. Women with absolute indications had lower mean gestational age and a higher proportion with >3 gravida than women with relative indications (p<0.05).Conclusion:The most common indications for first time cesarean, in decreasing order of frequency, were fetal distress, non-progression of labor, and breech presentation.

Antenatal Eğitimin Nullipar Kadınlarda Maternal ve Perinatal Sonuçlar Üzerine Etkisi

Objective: As a result of births in hospital instead of homes, antenatal education programs have been developed with the aim of preparing women for birth. The effect of antenatal education on pregnancy outcomes and birth process has not yet been fully clarified. The aim of the presented study was to evaluate whether antenatal education affects the maternal and perinatal outcomes in nulliparous women.Material and Methods: In this retrospective case-control study, medical records of 513 low-risk nulliparous women who gave birth between January 2010 and December 2016 at a tertiary care centre were reviewed. 85 women with antenatal education were included in the case group and 428 women who did not participate in the education program were included in the control group. The demographic, clinical characteristics, maternal and perinatal outcomes of groups were compared.Results: Mean age of women (26.0±4.4 vs. 23.5±4.4; p&amp;lt;0.001), history of abortion rate (5.9% vs. 0%; p&amp;lt;0.001) were higher and caesarean section rate (11.8% vs. 25.5%, p 0.006) was lower in women with antenatal education than in the control group. Caesarean indications, length of labour stages, episiotomy rates of women with vaginal delivery, postpartum complication rates, and perinatal outcomes of groups were similar. Conclusion: Antenatal education was associated with lower caesarean birth rates. There was no effect of antenatal education on the other maternal and perinatal outcomes.

Factors associated with Chinese pregnant women's preference for a cesarean section based on the theory of planned behaviour.

Cesarean delivery on maternal request is one of the important public health issues in China. Our study aimed to apply the theory of planned behaviour to comprehensively determine the factors regarding pregnant women's preference for cesarean section and to provide references for establishing measures to reduce cesarean delivery on maternal request. This cross-sectional analysis was conducted in four women's and children's hospitals in China from May to June 2018. Eligible women arriving for routine antenatal visits at these hospitals were recruited to answer a structured questionnaire. A total of 1853 pregnant women consented to participate in the investigation, with a response rate of 88.75%. Finally, 1677 pregnant women (984 nulliparae and 693 multiparae) were involved in the analysis. Descriptive statistics and logistic regression analyses were used. Of the study participants, 20.39% preferred cesarean section. For both nulliparae and multiparae, those who had lower scores of attitudes towards vaginal delivery, lower scores of childbirth self-efficacy and higher scores of subjective norms were more likely to prefer cesarean section. Pregnant women's birth preferences were significantly associated with their attitudes towards the delivery mode, childbirth self-efficacy and subjective norms, which is consistent with the theory of planned behaviour. Interventions to reduce cesarean delivery on maternal request can be developed based on the theory of planned behaviour.

The Association between Maternal Race and Ethnicity and Risk Factors for Primary Cesarean Delivery in Nulliparous Women

To understand whether maternal, perinatal, and systems-level factors can be identified to explain racial/ethnic disparities in cesarean delivery rates. This retrospective cohort study included nulliparous women with singleton gestations who delivered at a tertiary care center from 2015 to 2017. Maternal, perinatal, and systems-level factors were compared by race/ethnicity. Multilevel multivariable logistic regression was used to identify whether race/ethnicity was independently associated with cesarean. Effect modification was evaluated using interaction terms. Bivariable analyses and multinomial logistic regression were used to determine differences in indication for cesarean. Of 9,865 eligible women, 2,126 (21.5%) delivered via cesarean. The frequency of cesarean was lowest in non-Hispanic white women (19.2%) and highest in non-Hispanic black women (28.2%; p < 0.001). Accounting for factors associated with cesarean delivery did not lessen the odds of cesarean associated with non-Hispanic black race (aOR: 1.58, 95% CI: 1.31-1.91). Compared with non-Hispanic white women, non-Hispanic black women were more likely to undergo cesarean for nonreassuring fetal status (aOR: 2.73, 95% CI: 2.06-3.61). Examined maternal, perinatal, and systems-level risk factors for cesarean delivery did not explain the racial/ethnic disparities observed in cesarean delivery rates. Increased cesarean delivery for nonreassuring fetal status contributed substantially to this disparity.