Analysis of repeat cesarean delivery indications: implications of heterogeneity

Our purpose was to describe the relative contributions and characteristics of various subgroups of patients to the overall repeat cesarean delivery rate and to determine modifiable practice patterns that might lead to fewer repeat cesarean deliveries.

Hospital records of all women with a previous cesarean section who were delivered between Jan. 1 and June 30, 1994, at St. Peter's Medical Center in New Brunswick, New Jersey, were reviewed. Four groups were identified: (1) elective repeat cesarean, (2) "indicated" repeat cesarean, (3) failed vaginal birth after cesarean, and (4) successful vaginal birth after cesarean. Descriptive and outcome data were collected.

There were 406 patients, 376 of whom had complete records available for review. Of these, 235 had a repeat cesarean delivery because of the following reasons: elective (107, 45%), "indicated" (56, 24%), and failed vaginal birth after cesarean (72, 31%). The remaining 141 patients had a vaginal birth after cesarean. Patients with private or health maintenance organization insurance were nearly seven times more likely to have a repeat cesarean delivery as an elective procedure as compared with Medicaid or self-pay patients (odds ratio 6.88, 95% confidence interval 2.33 to 20.38). The failed vaginal birth after cesarean group was characterized by more frequent inductions of labor, less use of amniotomy, and very early epidural placement.

Examination of patient characteristics is required to identify population-specific strategies to reduce repeat cesarean delivery rates. Modifiable practice patterns exist that may lead to interventions to reduce repeat cesarean delivery rates.