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Rising cesarean rates: are patients sicker?
Jennifer L Bailit1, Thomas E Love, Brian Mercer
1Division of Maternal-Fetal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
American Journal of Obstetrics and Gynecology
|October 7, 2004
Summary
The rate of cesarean delivery (CD) is increasing, even for low-risk patients. This trend persists despite improvements in patient risk factors, suggesting other factors influence delivery decisions.
Area of Science:
- Obstetrics and Gynecology
- Maternal Health
- Public Health
Background:
- Cesarean delivery (CD) rates have been a growing concern globally.
- Understanding trends in CD risk factors is crucial for maternal healthcare.
- Previous studies have indicated a rise in CD rates, but changes in risk profiles over time require further investigation.
Purpose of the Study:
- To investigate whether patient risk factors for cesarean delivery (CD) are evolving over time.
- To analyze the changing demographics and risk profiles of women undergoing primary CD.
- To identify shifts in the population's susceptibility to cesarean birth.
Main Methods:
- Utilized North Carolina birth certificate data from 1995.
- Developed a logistic regression model to predict the probability of primary CD.
- Estimated individual patient probabilities of primary CD across four years for 397,793 deliveries.
- Compared the distribution of the population across 10 CD risk deciles over time.
Main Results:
- The incidence of primary CD increased from 16.6% to 18.4% (P<.0001).
- The proportion of women classified as low-risk (CD probability <10%) increased from 43.2% to 46.4% (P<.0001).
- Even within the lowest risk group, the cesarean rate rose from 4.6% to 5.9% (P<.0001).
Conclusions:
- The rate of primary cesarean delivery is on the rise.
- This increase is occurring despite an overall improvement in the patient risk profile.
- Potential drivers for the increasing CD rate include changes in physician behavior, institutional practices, and rising patient demand for elective cesarean delivery.