OBJECTIVES: To characterize the indications for primary cesarean delivery in a large national cohort and to identify opportunities to lower the U.S. primary cesarean delivery rate.
METHODS: A retrospective cohort study of the 38,484 primary cesarean deliveries among the 228,562 deliveries at sites participating in the Consortium on Safe Labor from 2002 to 2008.
RESULTS: The primary cesarean delivery rate was 30.8% for primiparous women and 11.5% for multiparous women. The most common indications for primary cesarean delivery were failure to progress (35.4%), nonreassuring fetal heart rate tracing (27.3%), and fetal malpresentation (18.5%), although frequencies for each indication varied by parity. Among women with failure to progress, 42.6% of primiparous women and 33.5% of multiparous women never progressed beyond 5 cm of dilation before delivery. Among women who reached the second stage of labor, 17.3% underwent cesarean delivery for arrest of descent before 2 hours and only 1.1% were given a trial of operative vaginal delivery. Of all primary cesarean deliveries, 45.6% were performed on primiparous women at term with a singleton fetus in cephalic presentation.
CONCLUSION: Using 6 cm as the cut-off for active labor, allowing adequate time for the second stage of labor, and encouraging operative vaginal delivery, when appropriate, may be important strategies to reduce the primary cesarean delivery rate. These actions may be particularly important in the primiparous woman at term with a singleton fetus in cephalic presentation.
LEVEL OF EVIDENCE: III
Conservative management of the latent stage and second stage of labor is an important strategy to lower the primary cesarean delivery rate.
Departments of Obstetrics and Gynecology, MedStar Washington Hospital Center and MedStar Georgetown University Hospital, Washington, DC; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; and MedStar Health Research Institute, Hyattsville, Maryland.
Corresponding author: Annelee Boyle, MD, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC 20010; e-mail: Annelee.C.Boyle@medstar.net.
From the Consortium on Safe Labor, which was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, through contract number HHSN267200603425C. For a list of institutions involved in the Consortium on Safe Labor, see the Appendix online at http://links.lww.com/AOG/A396.
Funded in part with Federal funds (grant number UL1RR031975) from the National Center for Research Resources and the National Center for Advancing Translational Science, and the National Institutes of Health, through the Clinical and Translational Science Awards Program, a trademark of the U.S. Department of Health and Human Services, part of the Roadmap Initiative, Reengineering the Clinical Research Enterprise.
Financial Disclosure The authors did not report any potential conflicts of interest.
The views expressed in this article are those of the authors and do not necessarily reflect the views of the National Institutes of Health or the Eunice Kennedy Shriver National Institute of Child Health and Development.