Cesarean Delivery Among Nulliparous Term Pregnancies with Hypertensive Disorders

To identify clinical and sociodemographic factors associated with cesarean delivery (CD) among nulliparous, term, singleton, vertex (NTSV) mothers with hypertensive disorders of pregnancy (HDP), and to determine if severity of HDP illness is associated with CD, as denoted by presence or absence of preeclampsia with severe features (sPEC).

Retrospective cohort of NTSV-HDP pregnancies delivered within a large academic health system in New York from 2019-2022. The primary exposure of interest was sPEC. The primary outcome was CD. A subanalysis was performed among pregnancies with sPEC to evaluate whether abnormal laboratory values or acute hypertension treatment are associated with CD. Mixed models logistic regression was performed to adjust for covariate factors.

A total of 5,202 NTSV-HDP pregnancies were included for analysis: 27.8% had sPEC. The overall CD rate was 37.5%. On logistic regression, sPEC was associated with 1.41 higher odds of CD compared to pregnancies without sPEC (95% CI 1.23-1.61). In the sPEC cohort, no association was seen between having abnormal laboratory testing and/or acute hypertension treatment and CD.

Among NTSV-HDP pregnancies, sPEC is associated with higher odds of CD. Further efforts should be made to lower CD rates in this high-risk population.