Contemporary cesarean delivery practice in the United States

Abstract

Objective-To describe contemporary cesarean delivery practice in the U.S.Study Design-Consortium on Safe Labor collected detailed labor and delivery information from 228,668 electronic medical records from 19 hospitals across the U.S., 2002 -2008. Results-The overall cesarean delivery rate was 30.5%. 31.2% of nulliparas were delivered by cesarean section. Prelabor repeat cesarean delivery due to a previous uterine scar contributed 30.9% of all cesarean sections. 28.8% of women with a uterine scar had a trial of labor and the success rate Corresponding author: Dr. Jun Zhang, Epidemiology Branch, NICHD, National Institutes of Health, Building 6100, Room 7B03, Bethesda, MD 20892, Tel: 301-435-6921, zhangj@mail.nih.gov. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptAm J Obstet Gynecol. Author manuscript; available in PMC 2011 October 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript was 57.1%. 43.8% women attempting vaginal delivery had induction. Half of cesarean for dystocia in induced labor were performed before 6 cm of cervical dilation.Conclusion-To decrease cesarean delivery rate in the U.S., reducing primary cesarean delivery is the key. Increasing VBAC rate is urgently needed. Cesarean section for dystocia should be avoided before the active phase is established, particularly in nulliparas and in induced labor.

Gestational diabetes, pre-pregnancy obesity and pregnancy weight gain in relation to excess fetal growth: variations by race/ethnicity

“…The CSL was a study initiated by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, in collaboration with 12 institutions across the USA and has been described in detail elsewhere [12]. In brief, this was a retrospective observational study of births between 2002 and 2008 from 19 hospitals, representing nine American College of Obstetricians and Gynecologists (ACOG) districts.…”

“…Data inquiries, cleaning and logic checking were performed. Validation studies determined that the constructed database was a highly valid representation of the electronic medical records [12].…”

Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population‐based ecological study with longitudinal data

“…Although some less developed countries, mostly in Africa, still have the rate below 10%, the majority of the countries have surpassed this recommendation and some have exceeded it by a wide margin 1, 2, 4. The reasons for such dramatic increases are multifactorial, including medical as well as non‐medical reasons 3, 6, 7. It has been suggested that non‐medical factors, such as social, cultural, or unequal accessibility to health services, as well as clinical practice patterns/styles, might have been major contributors to the wide variation in caesarean section rates across different countries 1, 2, 6, 7, 8, 9, 10.…”

Practice audits to reduce caesareans in a tertiary referral hospital in south-western China

“…Nevertheless, while the persistently elevated rates of caesarean delivery have drawn widespread public attention within China, no efforts to reduce them have ever been reported, perhaps because the results of non-clinical interventions targeting pregnant women and health-care professionals have been suboptimal in other settings. 18,19 Our institution, the First Affiliated Hospital of Kunming Medical University, is located in the province of Yunnan in south-western China. The province is similar to Malaysia in size but its population is almost double that of Malaysia.…”