Predictors of Cesarean Delivery for Periviable Neonates

Tucker Edmonds, Brownsyne MD, MPH; Fager, Corinne MS; Srinivas, Sindhu MD, MSCE; Lorch, Scott MD, MSCE

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e31821c4071
Original Research
Correction
Abstract

OBJECTIVE: To test for racial or ethnic disparities or both in periviable cesarean delivery and describe sociodemographic and clinical characteristics associated with periviable cesarean delivery.

METHODS: This was a retrospective cohort study of state-level maternal and neonatal hospital discharge data linked to vital statistics data for deliveries occurring between 23.0 and 24.6 weeks of gestation in California, Missouri, and Pennsylvania from 1995 to 2005 (N=8,290).

RESULTS: Approximately 79% of the population was aged 18–35 years, and almost half were nulliparous. Almost 20% of the women were African American, 36.4% were Hispanic, and 33.6% were white. Overall, 33.6% of periviable neonates were delivered by cesarean. In multivariable analyses adjusting for sociodemographic and clinical characteristics, cesarean delivery did not differ among African American and Hispanic women compared with white women (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.76–1.05; and OR 0.95, 95% CI 0.83–1.09, respectively). Women presenting with preterm labor were significantly less likely to undergo cesarean delivery (OR 0.84, 95% CI 0.73–0.96), whereas women presenting with preterm premature rupture of membranes (OR 1.29, 95% CI 1.14–1.45) or abruption (OR 2.43, 95% CI 2.09–2.81) were more likely to have cesarean deliveries. The strongest predictor of periviable cesarean delivery was pregnancy-induced hypertension (OR 15.6.4, 95% CI 12.3–19.7).

CONCLUSION: Unlike disparities observed at later gestational ages, cesarean delivery did not differ by race and ethnicity among this periviable cohort. Instead, medical indications such as pregnancy-induced hypertension, preterm premature rupture of membranes, or abruption were associated with a higher likelihood of cesarean delivery. Periviable deliveries represent a subset of deliveries, wherein race and ethnicity do not influence mode of delivery; the acuity of the clinical encounter dictates the course of care.

LEVEL OF EVIDENCE: II

In Brief

Clinical presentation and acuity, rather than maternal sociodemographic characteristics, predict cesarean delivery for periviable neonates.

Author Information

From the University of Pennsylvania, Robert Wood Johnson Foundation Clinical Scholars Program, Department of Obstetrics and Gynecology, Philadelphia, Pennsylvania; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; the University of Pennsylvania, Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Leonard Davis Institute, Philadelphia, Pennsylvania; and the University of Pennsylvania School of Medicine, Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Center for Outcomes Research, Leonard Davis Institute, Philadelphia, Pennsylvania.

Dr. Tucker Edmonds' salary is supported by the Robert Wood Johnson Foundation Clinical Scholars Program. The study is supported by the following granting agencies: MCHB R40 MC 05474 and AHRQ R01 HS 05696.

Corresponding author: Brownsyne Tucker Edmonds, University of Pennsylvania, 1303 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104; e-mail: tub@mail.med.upenn.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 The American College of Obstetricians and Gynecologists