ResearchObstetricsMeasurement and risk adjustment of prelabor cesarean rates in a large sample of California hospitals
Section snippets
Materials and Methods
We conducted a cross-sectional study using data from all inpatient admissions to Californian state-regulated hospitals in 2010 in the State Inpatient Database datasets of the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project. Our patient-level analytic dataset was constructed as follows (Appendix; Supplementary Table 1 and Figure 1). We included patient admissions with any instances of International Classification of Diseases, Ninth Revision, Clinical
Results
A total of 408,355 women met the study inclusion and exclusion restrictions (Figure 1). Of these women without prior cesarean, 44,731 women (10.95%) experienced a prelabor cesarean. They were significantly more likely to be older, of black race, from a ZIP code with higher household income, scheduled, and privately insured (Supplementary Table 2). Hispanic ethnicity was significantly less likely among women receiving a prelabor cesarean as was weekend admission and Medi-Cal (California's
Comment
In this study of >400,000 deliveries in women without a prior cesarean at 254 hospitals across California in 2010, 11.0% received a cesarean without laboring. This outcome varied very considerably across hospitals. We found large, significant differences between those who did experience the outcome and those who did not by maternal comorbidities, and maternal, fetal, and placental risk factors, but smaller and/or insignificant differences by hospital characteristics. Applying our well-fitting
Acknowledgments
The authors thank Ms Yuchen Ding for research assistance.
References (50)
- et al.
The relationship between cesarean delivery and gestational age among us singleton births
Clin Perinatol
(2008) - et al.
Late preterm infants, early term infants, and timing of elective deliveries
Clin Perinatol
(2008) - et al.
A comparison of urinary and sexual outcomes in women experiencing vaginal and cesarean births
J Obstet Gynaecol Can
(2005) - et al.
A review of issues surrounding medically elective cesarean delivery
J Obstet Gynecol Neonatal Nurs
(2007) - et al.
Vaginal birth after cesarean: clinical risk factors associated with adverse outcome
Am J Obstet Gynecol
(2008) - et al.
Age and racial/ethnic differences in maternal, fetal, and placental conditions in laboring patients
Am J Obstet Gynecol
(2003) Choosing cesarean section
Lancet
(2000)- et al.
Patient education and the impact of new medical research
J Health Econ
(2009) - et al.
Patterns of obstetric infection rates in a large sample of US hospitals
Am J Obstet Gynecol
(2013) - et al.
Creating a public agenda for maternity safety and quality in cesarean delivery
Obstet Gynecol
(2012)
Cesarean delivery rate and neonatal morbidity in a low-risk population
Am J Obstet Gynecol
Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term
CMAJ
Mothers' reports of postpartum pain associated with vaginal and cesarean deliveries: results of a national survey
Birth
Relative risk of postpartum complications in the Ohio Medicaid population: vaginal versus cesarean delivery
Med Care Res Rev
“Late-preterm” infants: a population at risk
Pediatrics
Achieving exclusive breastfeeding in the United States
Cesarean childbirth and psychosocial outcomes: a meta-analysis
Health Psychol
Risks of adverse outcomes in the next birth after a first cesarean delivery
Obstet Gynecol
Cesarean delivery and risk of stillbirth in subsequent pregnancy: a retrospective cohort study in an English population
Br J Obstet Gynaecol
Cesarean section and postnatal sexual health
Birth
Maternal risk profiles and the primary cesarean rate in the United States, 1991-2002
Am J Public Health
Appropriate technology for birth
Lancet
Cited by (11)
The risk of prelabor and intrapartum cesarean delivery among overweight and obese women: Possible preventive actions
2015, American Journal of Obstetrics and GynecologyCitation Excerpt :We found an increased risk of prelabor cesarean delivery for multiparous women with no uterine scar after adjustment for maternal and pregnancy-related complications. Several other studies have also reported elevated risks of prelabor cesarean delivery for multiparous women without previous cesarean delivery.43,44 Higher risks of prelabor cesarean delivery may reflect obstetricians’ anxiety about emergency cesarean deliveries after the onset of labor in technically difficult conditions.
Design characteristics of studies on medical practice variation of caesarean section rates: A scoping review
2020, BMC Pregnancy and ChildbirthA Spatial View of How United States Cesarean Section Rates Changed from 1990 to 2014
2019, Professional GeographerMode of delivery in pregnancies with gastroschisis according to delivery institution
2019, Journal of Maternal-Fetal and Neonatal Medicine
The authors acknowledge specific grant support from the Agency for Healthcare Research and Quality under grant R21 HS021868-01 (principal investigator: M.D.H.). The findings and conclusions in this report are those of the authors, were not reviewed by funder representatives, and no endorsement by the Agency for Healthcare Research and Quality is intended or should be inferred.
The authors report no conflict of interest.
Cite this article as: Huesch MD, Currid-Halkett E, Doctor JN. Measurement and risk adjustment of prelabor cesarean rates in a large sample of California hospitals. Am J Obstet Gynecol 2014;210:443.e1-17.