Contemporary Trends in Cesarean Delivery Rates and Indications.

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Health Services Research

Background:

• Guidelines from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine were published in 2014 to reduce cesarean delivery rates.
• Understanding trends in cesarean delivery rates and indications is crucial for evaluating the effectiveness of these guidelines.

Purpose of the Study:

• To describe cesarean delivery rates and indications at a single tertiary care center.
• To assess the impact of 2014 guidelines on labor management trends.

Main Methods:

• Retrospective cohort study of 24,050 deliveries from 2013-2018.
• Chart review to determine cesarean delivery rates and indications (repeat cesarean, nonreassuring fetal status, malpresentation, maternal, failed labor, other).
• Polynomial regression models used to analyze trends over time, with subgroup analysis for nulliparous women.

Main Results:

• Overall cesarean delivery rates varied significantly over time (30.9% in 2014 to 34.6% in 2018), with no significant change in overall indications.
• In nulliparous women, cesarean rates also varied significantly (35.4% in 2013 to 33.9% in 2018), with no significant change in primary indications except for nonreassuring fetal status.
• Indications such as failed labor, repeat cesarean, and malpresentation did not significantly change over time in either group.

Conclusions:

• The 2014 guidelines did not lead to a decrease in overall cesarean delivery rates.
• Key indications for cesarean delivery remained stable, suggesting a need for additional strategies to promote vaginal birth.
• Further research and interventions are necessary to effectively reduce cesarean delivery rates and improve labor management outcomes.