Risk Of Primary Cesarean Delivery Research Articles

The Combined Influence of Maternal Medical Conditions on the Risk of Primary Cesarean Delivery.

Background Common maternal medical comorbidities such as hypertensive disorders, diabetes, tobacco use, and extremes of maternal age, body mass index, and gestational weight gain are known individually to influence the rate of cesarean delivery. Numerous studies have estimated the risk of individual conditions on cesarean delivery. Objective To examine the risk for primary cesarean delivery in women with multiple maternal medical comorbidities to determine the cumulative risk they pose on mode of delivery. Study Design In this population-based retrospective cohort study, we analyzed data from Ohio live birth records from 2006 to 2015 to estimate the influence of individual and combinations of maternal comorbidities on rates of singleton primary cesarean delivery. The exposures were individual and combinations of maternal medical conditions (chronic hypertension [CHTN], gestational hypertension, pregestational diabetes, gestational diabetes, tobacco use, advanced maternal age, and maternal obesity) and outcomes were rates and adjusted relative risk (aRR) of primary cesarean delivery. Results There were 1,463,506 live births in Ohio during the study period, of which 882,423 (60.3%) had one or more maternal medical condition, and of those 243,112 (27.6%) had primary cesarean delivery. The range of rates and aRR range of primary cesarean delivery were 13.9 to 29.3% (aRR 0.78-1.68) in singleton pregnancies with a single medical condition, and this increased to 21.9 to 48.6% (aRR 1.34-3.87) in pregnancies complicated by multiple medical comorbidities. The highest risk for primary cesarean occurred in advanced maternal age, obese women with pregestational diabetes, and CHTN. Conclusion A greater number of maternal medical comorbidities during pregnancy is associated with increasing cumulative risk of primary cesarean delivery. These data may be useful in counseling patients on risk of cesarean during pregnancy.

489 Do fetal biometry parameters> 90th percentile increase the risk of Primary Cesarean Delivery?

489 Do fetal biometry parameters> 90th percentile increase the risk of Primary Cesarean Delivery?

Vitamin D Deficiency in Pregnancy: A Systematic Review

Vitamin D deficiency (VDD) is a common problem in reproductive-aged women and has become a major public health problem worldwide. Adverse health outcomes such as preeclampsia, low birthweight, neonatal hypocalcemia, poor postnatal growth, bone fragility, and increased incidence of autoimmune diseases have been linked to low vitamin D levels during pregnancy and infancy. A systematic literature search was performed on September 6th – 21st, 2022 using respected database. The identified articles were screened using the chosen eligibility criteria. Literature selection was performed with rest time restriction from January 1, 2017, and September 22, 2022 and restricted to only published in English articles. Three papers were evaluated in full-text after duplicates were removed. Tammo et al, Mansur et al and Moralez et al were the three studies that remained following full-text screening utilizing eligibility criteria and quality assessment showing a significant proof regarding this review. Vitamin D deficiency had wide variety of effects in pregnancy as it may increased risk of multisystem disorders in pregnancy such as preeclampsia, low birth weight in neonates, insulin resistance, gestational diabetes mellitus (GDM), and a higher risk of primary cesarean delivery. Optimal level of 30 ng/mL or more before conception and throughout the entire pregnancy with different dosages available, avoiding levels below 20 ng/ml.

Trends in racial and ethnic disparity for the risk of primary cesarean delivery

The primary cesarean delivery rate has significantly increased over time leading to important impacts on maternal morbidity and mortality. Racial disparities in obstetric care have been well well-established, and may impact primary cesarean delivery rates. The aim of this study is to describe trends in rates and indications for primary cesarean delivery by race and ethnicity.

Language Preference and Risk of Primary Cesarean Delivery: A Retrospective Cohort Study.

While some medical indications for cesarean delivery are clear, subjective provider and patient factors contribute to the rising cesarean delivery rates and marked disparities between racial/ethnic groups. We aimed to determine the association between language preference and risk of primary cesarean delivery. We conducted a retrospective cohort study of nulliparous, term, singleton, vertex (NTSV) deliveries of patients over 18years old from 2011-2016 at an academic medical center, supplemented with data from the Massachusetts Department of Public Health. We used modified Poisson regression with robust error variance to calculate risk ratios for cesarean delivery between patients with English language preference and other language preference, with secondary outcomes of Apgar score, maternal readmission, blood transfusion, and NICU admission. Of the 11,298 patients included, 10.3% reported a preferred language other than English, including Mandarin and Cantonese (61.7%), Portuguese (9.7%), and Spanish (7.5%). The adjusted risk ratio for cesarean delivery among patients with a language preference other than English was 0.85 (95% CI 0.72-0.997; p = 0.046) compared to patients with English language preference. No significant differences in risk of secondary outcomes between English and other language preference were found. After adjusting for confounders, this analysis demonstrates a decreased risk of cesarean delivery among women who do not have an English language preference at one institution. This disparity in cesarean delivery rates in an NTSV population warrants future research, raising the question of what clinical and social factors may be contributing to these lower cesarean delivery rates.

262 Risk of primary cesarean delivery among non-english speaking nulliparous women

Demographic factors such as maternal age, race, ethnicity, and socioeconomic status are known to affect rates of primary Cesarean delivery. However, effect of a patient’s primary language on rate of Cesarean is unknown. We sought to examine the association between rate of primary unscheduled Cesarean delivery and preferred patient language. A retrospective cohort study was conducted at a large urban medical center between 8/2018 and 1/2020. Inclusion criteria were nulliparity, full term gestation, and having no obstetric or medical contraindication to vaginal delivery. Multiparous women, women with medical contraindications to vaginal delivery, scheduled cesarean deliveries, preterm and multifetal gestations were excluded from the analysis. We used multivariable analyses to evaluate language differences in risk of cesarean delivery. 1316 women were eligible for this study. The overall rate of cesarean delivery was 27.9%. Of this cohort, 76.7% of patients preferred English, 18% Spanish and 5.3% other (all other languages). Spanish and other-speaking women had significantly higher odds of undergoing Cesarean compared to English-speaking women (odds ratio: 1.45; 95% CI: 1.10, 1.91), which remained significant when controlling for factors such as maternal age, race, ethnicity, BMI, insurance type, maternal co-morbidities, labor induction, and infant birthweight (adjusted odds ratio: 1.63; 95% CI: 1.15, 2.32). Interpreter use was documented in 52.1% of non-English speaking admissions. Cesarean delivery rates differ by patient’s preferred language. Specifically, primary cesarean delivery rates were found to be significantly higher among non-English speaking nulliparous women. This difference may be reflective of lack of effective communication during clinical encounters, provider bias, or other factors and should be further studied. Interpreter services should be utilized and documented effectively.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

1193: The combined influence of multiple maternal medical conditions on incidence of primary cesarean section

Common maternal medical co-morbidities such as hypertensive disorders, diabetes, tobacco use, and extremes of maternal age, BMI, and gestational weight gain, are known individually to have impact on the rate of cesarean delivery. Numerous prior studies have estimated the risk of individual risk factors on cesarean delivery, but many parturients have more than one condition that may compound cesarean risk. We aim to examine the risk for cesarean delivery in women with multiple maternal medical co-morbidities to determine the cumulative risk they pose on pregnancy. In this retrospective cohort study we analyzed data from the Ohio live birth records from 2006-2015 with the goal to estimate the influence of individual and combinations of maternal co-morbidities on rates of primary cesarean delivery. The exposures were individual and combined maternal morbidities (chronic hypertension, gestational hypertension, pre-gestational diabetes, tobacco use, advanced maternal age, obesity, and insufficient gestational weight gain) and outcomes were rates and adjusted relative risk (aRR) of Cesarean. There were 1,463,506 live births in Ohio during the study period, of which 1,044,570 (71.3%) had one or more risk factor. The rate and aRR range of Cesarean delivery were 19.9-36.2% (aRR 1.15-1.96) in pregnancies with a single risk factor and this increased to 29.8-45.8% (aRR1.54-2.70) in pregnancies complicated by multiple medical co-morbidities, see figures. A greater number of maternal medical co-morbidities during pregnancy is associated with increasing cumulative risk of primary cesarean delivery. These data provide specific estimates of risk with a variety of combinations of medical co-morbidities, which may be used for patient counseling, risk stratification and pregnancy management planning.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Risk of Primary Cesarean Delivery: Role of Language Preference and Language-Concordant Labor Support [17D

Risk of Primary Cesarean Delivery: Role of Language Preference and Language-Concordant Labor Support [17D

A cohort study of maternal cardiometabolic risk factors and primary cesarean delivery in an integrated health system.

BackgroundMaternal cardiometabolic risk factors (i.e., hyperglycemia, pre-existing hypertension and high body mass index) impact fetal growth and risk of having a cesarean delivery. However, the independent and joint contribution of maternal cardiometabolic risk factors to primary cesarean section is unclear. We aimed to elucidate the degree to which maternal cardiometabolic risk factors contribute to primary cesarean deliveries and whether associations vary by infant size at birth in an integrated health system.MethodsA cohort study of 185,045 singleton livebirths from 2001 to 2010. Poisson regression with robust standard errors provided crude and adjusted relative risks (RR) and 95% confidence intervals (CIs) for cesarean delivery risk associated with risk factors. We then estimated the proportion of cesarean sections that could be prevented if the cardiometabolic risk factor in pregnant women were eliminated (the population-attributable risk [PAR]).ResultsIn a single multivariable model, maternal cardiometabolic risk factors were independently associated with cesarean delivery: RR (95% CI) abnormal glucose screening 1.04 (1.01–1.08); gestational diabetes 1.18 (1.11–1.18) and pre-existing diabetes 1.60 (1.49–1.71); pre-existing hypertension 1.16 (1.10–1.23); overweight 1.27 (1.24–1.30); obese class I 1.46 (1.42–1.51); obese class II 1.73 (1.67–1.80); and obese class III 1.97 (1.88–2.07); adjusting for established risk factors, medical facility and year. The associations between maternal cardiometabolic risk factors and primary cesarean delivery remained among infants with appropriate weights for gestational age. The PARs were 17.4% for overweight/obesity, 7.0% for maternal hyperglycemia, 2.0% for pre-existing hypertension and 20.5% for any cardiometabolic risk factor.ConclusionsMaternal cardiometabolic risk factors were independently associated with risk of primary cesarean delivery, even among women delivering infants born at an appropriate size for gestational age. Effective strategies to increase the proportion of women entering pregnancy at an optimal weight with normal blood pressure and glucose before pregnancy could potentially eliminate up to 20% of cesarean deliveries.

Relationship Between Labor and Delivery Unit Management Practices and Maternal Outcomes

(Obstet Gynecol. 2017;130(2):358–365) The specific management practices of labor and delivery units and their sensitivity to operational pressures have not been well assessed in the context of improved patient outcomes. In the present review, the authors assessed whether or not labor and delivery unit management practices that proactively mitigated unit challenges were independently associated with lower risk of primary cesarean delivery, prolonged length of stay, and adverse maternal outcomes in low-risk patients.

Maternal Body Mass Index and Amniotic Fluid Index in Late Gestation.

To determine the effect, if any, of an increasing maternal body mass index (BMI) on sonographically diagnosed oligohydramnios in late gestation and how it subsequently affects obstetric and neonatal outcomes. This retrospective cohort study evaluated all women with singleton gestations who had a sonographic examination at 40 to 42 weeks' gestational age at North Shore University Hospital from 2010 through 2013. Underweight women (prepregnancy BMI < 18.5 kg/m2 ) were excluded because of higher rates of oligohydramnios and fetal growth restriction. Patients were classified into 5 groups by late-pregnancy BMI. The primary variable of interest was the diagnosis of oligohydramnios (amniotic fluid index < 5 cm). Secondary variables of interest included the mode of delivery and indication for primary cesarean delivery. A multivariable logistic regression analysis was performed. Oligohydramnios was identified in 189 of 1671 patients (11.3%). There was no significant difference in the amniotic fluid index between BMI groups. The rate of primary cesarean delivery increased with each successive BMI group (P < .001) such that women in the class III obesity group had an approximately 3-fold higher rate of primary cesarean delivery than women in the normal BMI group and a 2-fold higher rate than women in the overweight BMI group. In the final multivariable logistic regression model, a high BMI, nulliparity, and excessive gestational weight gain were associated with primary cesarean delivery. However, oligohydramnios did not contribute significantly to the model. The maternal BMI is not associated with oligohydramnios in late gestation. An increasing maternal BMI significantly increases the risk of primary cesarean delivery.

Risk of Primary Cesarean Delivery in Women With Pregnancy-Associated Hypertension [7C

INTRODUCTION: Despite the lack of evidence supporting cesarean delivery (CD) in the setting of pregnancy-associated hypertension (PAH), women with this diagnosis continue to have high CD rates. The aim of this study is to determine whether the higher rate of primary CD among women with PAH can be explained by the presence of other known CD risk factors. METHODS: A retrospective cohort study of singleton, vertex, nulliparous women delivering between 34 and 42 weeks using the 2013 US National Vital Statistics Report dataset. Rates of primary CD in women with and without PAH were compared. Multivariate logistic regression predicted CD after controlling for known risk factors, including advanced maternal age (AMA), race/ethnicity, gestational age, pre-pregnancy BMI, US residency, insurance type, prenatal care, diabetes, and eclampsia. RESULTS: We analyzed 1,103,999 women, including 94,332 women diagnosed with PAH. The unadjusted CD rate in women with PAH was 41.3% compared to 26.9% in those without PAH (p &lt; 0.01). Each analyzed risk factor was significantly associated with CD (Table). However, even after controlling for these risk factors, the predicted probability of CD in a woman with PAH would be 37.2% vs 26.5% without PAH (p &lt; 0.01). PAH remained an independent predictor for CD (aOR 1.68 [95% CI 1.65-1.71]). CONCLUSION: After controlling for other risk factors, diagnosis of PAH alone is a significant risk factor for CD, likely reflecting a widespread practice that is not supported by the most recent clinical evidence. Women with PAH may therefore represent an important target population for efforts that aim to reduce primary CD rates.

Weight Gain: A Modifiable Risk Factor for Primary Cesarean Delivery

Objective: To evaluate the relationship between weight gain and primary cesarean delivery. Methods: This was a retrospective cohort study of women 5442 who delivered a singleton from 2009-2013. Women were classified as normal weight [pre-pregnancy body mass index (BMI) 18.5 - 24.9 kg/m2], overweight (pre-pregnancy BMI 25.0 - 29.9 kg/m2), obese (pre-pregnancy BMI 30.0 - 39.9 kg/m2), and extremely obese (pre-pregnancy BMI ≥ 40.0 kg/m2). Each BMI group was subdivided by weight gain—low, recommended, or excessive, as defined by the 2009 Institute of Medicine guidelines—and rates of primary cesarean delivery were compared. Results: The overall primary cesarean delivery rate was 27.3%, but this varied based on pre-pregnancy BMI. The primary cesarean delivery rate among women of normal weight was 22.3%, overweight women 27.5%, obese women 35.3%, and extremely obese women 45.7%. Among normal-weight, obese, and extremely obese women, the risk of primary cesarean delivery increased with excessive weight gain [normal weight odds ratio (OR) 1.63, (95% confidence interval 1.32 - 2.01); obese OR 1.55 (1.12 - 2.15); extremely obese OR 2.19 (1.18 - 4.08)] compared to recommended weight gain. More than half of women (53.2%) had excessive weight gain. Conclusion: Adherence to guidelines may decrease a woman’s risk of primary cesarean delivery.

Retrospective evaluation of perinatal outcome in women with mild gestational hyperglycemia

To assess maternal and perinatal complications associated with mild gestational hyperglycemia (MGH). This retrospective study was conducted in the perinatology division of Zekai Tahir Burak Women's Hospital between January and June 2009. Four hundred and eighty one patients with MGH and 212 patients with pre-gestational diabetes or gestational diabetes mellitus (GDM) were recruited in the study. The control group consisted of 479 patients with normal glucose challenge test. Patients with MGH and the control group were compared in terms of maternal and neonatal complications. The rates of large-for-gestational-age (LGA) or macrosomic infants, pregnancy induced hypertension, primary cesarean delivery, preterm delivery and neonatal hypoglycemia were significantly higher in patients with MGH, GDM or preexisting diabetes. The rates of spontaneous preterm labor, shoulder dystocia, hyperbilirubinemia, low 1-min Apgar score, fetal malformations and neonatal morbidity did not differ between the groups. MGH is associated with an increased risk of primary cesarean delivery, preterm delivery, pregnancy induced hypertension, and macrosomic and LGA infants.

OP30.05: Clinical and sonographic parameters at mid‐trimester to predict the risk of primary Cesarean delivery in nulliparas

OP30.05: Clinical and sonographic parameters at mid‐trimester to predict the risk of primary Cesarean delivery in nulliparas

Clinical and sonographic parameters at 37 weeks' gestation for predicting the risk of primary Cesarean delivery in nulliparous women

To identify the clinical and sonographic parameters at 37 weeks' gestation that predict the risk of Cesarean delivery in labor for nulliparas. This prospective observational study recruited nulliparas with singleton pregnancies at 37 weeks' gestation. Determination of the Bishop score, ultrasound measurement of the cervical length, and fetal biometry were performed. The clinical parameters studied were maternal age, height and weight and Bishop score. The sonographic parameters included fetal biparietal diameter, femur length, abdominal circumference (AC), estimated fetal weight (EFW), amniotic fluid index and cervical length. Four hundred and fifty-three women were examined; 57 women (12.6%) underwent an emergency Cesarean delivery in labor. Logistic regression analysis identified maternal age and height and fetal AC and EFW, but not cervical length or Bishop score, as the best predictors of Cesarean delivery. Of these predictors, maternal age and height and fetal AC at 37 weeks were included in a final model for risk scoring. The model was shown to have an adequate goodness of fit (P = 0.473), and the area under the receiver-operating characteristics curve was 0.758, indicating reasonably good discrimination. Maternal age and height and fetal AC and EFW at 37 weeks' gestation are the most important parameters in predicting the risk of Cesarean delivery in nulliparas; sonographic measurement of the cervical length and the Bishop score were not predictive of Cesarean delivery. A predictive model using these parameters at 37 weeks provides useful information in the decision-making process regarding the mode of delivery.

Cervical Length at Mid-Pregnancy and the Risk of Primary Cesarean Delivery

Smith, G. C. S.; Celik, E.; Meekai, T.; Khouri, O.; Nicolaides, K. H. for the Fetal Medicine Foundation Second Trimester Screening Group Author Information

Cervical Length at Mid-Pregnancy and the Risk of Primary Cesarean Delivery

Cervical Length at Mid-Pregnancy and the Risk of Primary Cesarean Delivery

Cervical Length at Mid-Pregnancy and the Risk of Primary Cesarean Delivery

Previous research suggests that normal term birth depends on programmed development of the uterus in early pregnancy. A short cervix in mid-pregnancy is associated with an increased risk of spontaneous preterm birth. The present study tested the hypothesis that a long cervix in mid-pregnancy is associated with a higher risk of cesarean delivery during term labor. The study population included 27,472 primiparous women whose cervical length was 16 mm or more at a median gestational age of 23 weeks, and who delivered a live infant in labor at term. Cervical length was estimated by transvaginal ultrasonography. The rate of cesarean delivery at term was lowest (16%) in women whose mid-pregnancy cervical length was in the lowest quartile (16–30 mm). The rate was progressively greater in the second quartile (18%, 31–35 mm), third quartile (22%, 36–39 mm), and fourth quartile (26%, 40–67 mm). Compared with women in the first quartile, the odds ratio (OR) for cesarean delivery in women in the fourth quartile was 1.8 (95% confidence interval [CI], 1.66–1.97). The OR was 1.68 (95% CI, 1.53–1.84) after adjusting for numerous variables including maternal age, body mass index, smoking status, race or ethnic group, gestational age at birth, spontaneous or induced labor, and birth weight percentile. The association with cervical length was slightly stronger when the outcome was limited to operative delivery mandated by the failure of labor to progress. An increased cervical length during mid-pregnancy appears to independently predict the risk of cesarean delivery during labor at term in primiparous women. This finding suggests that poor progress during labor in women who deliver at term may reflect dysfunctional development of the uterus at earlier stages of pregnancy.

Cervical Length at Mid-Pregnancy and the Risk of Primary Cesarean Delivery

Physiological and biochemical studies suggest that normal parturition at term is dependent on programmed development of the uterus in early pregnancy. It is recognized that a short cervix in mid-pregnancy is associated with an increased risk of spontaneous preterm birth. We hypothesized that a long cervix in mid-pregnancy would be associated with an increased risk of cesarean delivery during labor at term. We studied 27,472 primiparous women who had a cervical length of 16 mm or more at a median of 23 weeks of gestation and who ultimately delivered a live infant in labor at term. The rate of cesarean delivery at term was lowest (16.0%) among women with a mid-pregnancy cervical length in the lowest quartile (16 to 30 mm) and was significantly greater in the second quartile (18.4%, 31 to 35 mm), third quartile (21.7%, 36 to 39 mm), and fourth quartile (25.7%, 40 to 67 mm) (P<0.001 for trend). The odds ratio for cesarean delivery among women in the fourth quartile, as compared with the first quartile, was 1.81 (95% confidence interval [CI], 1.66 to 1.97), and the odds ratio adjusted for maternal age, body-mass index, smoking status, race or ethnic group, gestational age at birth, spontaneous or induced labor, birth-weight percentile, and hospital of delivery was 1.68 (95% CI, 1.53 to 1.84; P<0.001). The increased risk of cesarean delivery was attributable to procedures performed for poor progress in labor. The cervical length at mid-pregnancy is an independent predictor of the risk of cesarean delivery at term in primiparous women.