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Repeat cesareans: how many are elective?

K D Gregory1, O A Henry, A J Gellens

  • 1Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, California.

Obstetrics and Gynecology
|October 1, 1994
PubMed
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Repeat cesarean deliveries are often elective, unlike primary cesareans which are mainly due to dystocia. Differentiating indications for repeat cesarean delivery is crucial for future studies.

Area of Science:

  • Obstetrics and Gynecology
  • Reproductive Health
  • Surgical Outcomes

Background:

  • Cesarean delivery rates have been a public health concern.
  • Understanding indications for repeat cesarean births is essential for optimizing maternal care.
  • Current coding systems may not adequately differentiate between elective and medically indicated repeat cesareans.

Purpose of the Study:

  • To delineate the clinical reasons for repeat cesarean deliveries.
  • To contrast these indications with those for primary cesarean procedures.

Main Methods:

  • A retrospective review of 1885 cesarean deliveries was conducted at an academic nonprofit hospital in 1992.
  • Indications were extracted from surgeon operative reports and International Classification of Diseases, Clinical Modification, 9th Edition (ICD-9) codes.

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Main Results:

  • The hospital's cesarean delivery rate was 28.7%, with 34% being repeat procedures.
  • Elective cesarean delivery was the primary indication for repeat procedures, followed by dystocia and fetal distress.
  • Dystocia was the leading indication for primary cesareans, contrasting with repeat procedures.

Conclusions:

  • Existing ICD-9 code hierarchies do not distinguish between elective and indicated repeat cesarean deliveries.
  • Recommendations to reduce cesarean rates by promoting vaginal birth after cesarean (VBAC) may overlook clinically indicated repeat procedures.
  • A refined coding system differentiating elective from indicated repeat cesareans is needed for future research.