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A national estimate of the elective primary cesarean delivery rate
Susan F Meikle1, Claudia A Steiner, Jun Zhang
1Agency for Healthcare Research and Quality, Rockville, MD 20850, USA. smeikle@ahrq.gov
Insights
Elective primary cesarean delivery rates increased by 43.6% nationally between 1994 and 2001. Indications for these procedures also shifted, highlighting the need for updated terminology and surveillance in obstetric practice.
Area of Science:
- Obstetrics and Gynecology
- Public Health Surveillance
- Healthcare Informatics
Background:
- Elective primary cesarean delivery (EPCD) rates have been a subject of interest due to variations in practice.
- Understanding national trends and the evolution of indications for EPCD is crucial for obstetric care.
- Changes in coding practices can influence the reported rates and reasons for cesarean deliveries.
Purpose of the Study:
- To analyze national trends in elective primary cesarean delivery rates from 1994 to 2001.
- To examine shifts in the documented indications for EPCD during the study period.
- To assess the impact of coding changes on the identification of EPCD indications.
Main Methods:
- Utilized data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample.
- Identified cesarean deliveries using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes.
- Targeted twelve specific indications for EPCD and evaluated ICD-9-CM coding changes.
Main Results:
- EPCD rose from 19.7% to 28.3% of all cesarean deliveries between 1994 and 2001, a 43.6% increase.
- Increased use of codes for malpresentation, antepartum bleeding, hypertension, macrosomia, unengaged head, preterm gestation, and maternal soft tissue disorders.
- Rapid adoption of a new 1998 code for fetal heart rate abnormalities was observed.
Conclusions:
- A significant national increase in elective primary cesarean delivery rates was observed.
- The coded indications for EPCD are undergoing a shift, necessitating further investigation.
- Improved national surveillance and revised terminology for cesarean delivery indications are recommended for future obstetric practice.
Objective:
We describe national trends for elective primary cesarean delivery from 1994 to 2001, with attention to changes in indications.
Methods:
We used data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Cesarean deliveries were identified by International Classification of Diseases, 9th Revision, Clinical Modification procedure and diagnostic codes; V codes identified all types of deliveries for denominators. Twelve indications for elective primary cesarean delivery were targeted. International Classification of Diseases, 9th Revision, Clinical Modification coding changes were also evaluated.
Results:
After excluding women who had labored and previous cesarean deliveries, elective primary cesarean deliveries rose from 19.7% of all cesarean deliveries in 1994 to 28.3% in 2001, an increase of approximately 43.6%. The use of the identified indications for elective primary cesarean delivery increased for codes representing malpresentation, antepartum bleeding, hypertension and severe hypertension, macrosomia, unengaged head, preterm gestation, and maternal soft tissue disorders. Coding for herpes, multiple gestation, other uterine scar, and congenital central nervous system remained the same. Additionally, a new 1998 code for fetal heart rate abnormalities was rapidly adopted during the study period.
Conclusion:
A national estimate of the elective primary cesarean delivery rate shows a rising trend. Additionally, coded indications for these procedures are shifting. Further examination into the use and clinical implications of indications through national surveillance for elective primary cesarean delivery is important for future obstetric practice. A revision of the terminology classification used to identify indications for cesarean delivery procedures would aid in this effort.
Level Of Evidence:
III.
