Abstract
Objective: To determine the contribution that pre-labor cesarean
(cesarean performed without attempting vaginal birth) makes to all
cesarean births, and to cesarean births within subgroups of the pregnant
population. Design: Retrospective cohort study. Setting: 15 hospitals in
the Pacific Northwest of the United States. Population: Births at
23+0-42+6 weeks’ gestation between January 1, 2017 and March 31, 2018.
Methods: Review of clinical data abstracted from medical records. Main
Outcome Measures: The contribution of pre-labor cesarean to all
cesareans and to primary cesareans. The indications for pre-labor
primary cesarean in singleton term cephalic pregnancies. Results: Of
32756 births in the study population, 10290 (31.4%) were cesarean
births. Pre-labor cesareans represented: 63.7% of all cesareans; 32.4%
of cesareans in nulliparas; 58.7% of cesareans in multiparas with no
history of cesarean; and 20.0% of all births. Pre-labor cesareans
constituted 68.3% (2418/3542) of cesareans in singleton term cephalic
multiparas with one previous cesarean, 89.4% (356/398) of cesareans in
multiple pregnancies, and 53.2% (216/406) of cesareans in twin
pregnancies where Baby A was cephalic. In singleton term cephalic
pregnancies with no previous cesarean 18.3% (674/3682) of cesareans
were pre-labor and suspected macrosomia (28.9%) and maternal request
(18.1%), jointly accounted for 47.0% of indications for these
surgeries. Conclusions: Cesarean without attempting vaginal birth is a
major contributor to both primary and repeat cesarean birth rates.
Greater tracking of the rate and indications for these cesarean births
may be important in the effort to understand and potentially reduce the
primary cesarean birth rate.