Cesarean deliveries at a university hospital: analysis of rates and indications

The objective of this paper is to evaluate the influence of patient risk status on the incidence of and indications for cesarean delivery. All live births > or = 23 weeks at the University of Vermont in 1995 (n = 2395) were retrospectively analyzed for delivery route, indication for cesarean, gestational age, parity, and practice group (to reflect risk status). The total cesarean rate was 14.4% (344 of 2395), and the primary rate was 11.4% (244 of 2144). Abnormal presentation was the most common indication (25.6%, 88 of 344). The "corrected" cesarean rate (maternal-fetal medicine and transported patients excluded) was 12.4% (273 of 2194), and the "corrected" primary rate was 9.6% (190 of 1975). Furthermore, when all deliveries were analyzed, regardless of risk status but limited to gestational age > or = 36 weeks, the rates did not change (12.6%, 280 of 2214; primary 9.2%, 183 of 1994). Arrest of dilation was the most common indication in both "corrected" subgroups (23.4 and 24.6%, respectively). Cesarean rates at tertiary care hospitals should be compared with rates at community hospitals only after correcting for dissimilar patient groups or gestational age.