Low-risk cesarean deliveries decreased over last 20 years

Key takeaways :

• The average annual percentage change for low-risk cesarean deliveries was –2.2% from 2009 to 2019.
• Rates of cesarean delivery for nonreassuring fetal status rose and for labor arrest fell during the study period.

Low-risk cesarean deliveries decreased over the study period, with cesarean deliveries for labor arrest growing less common and those for nonreassuring fetal status increasing, according to study findings.

“There are limited national data on trends in indications for cesarean delivery. The national outcomes of changes in clinical practice, particularly with respect to diagnosis of labor arrest, are unknown,” Anna M. Frappaolo, BA, medical student in the division of maternal-fetal medicine in the department of obstetrics and gynecology at Columbia University College of Physicians and Surgeons, and colleagues wrote in JAMA Network Open. “Given these knowledge gaps, the purposes of this study were to determine temporal trends in cesarean deliveries among patients at low risk for cesarean delivery over a 20-year period in the U.S. and analyze trends in specific cesarean delivery indications.”

Researchers evaluated 76.7 million delivery hospitalizations from 2000 to 2019 using the National Inpatient Sample and identified 4,885,716 cesarean delivery births. Researchers assessed temporal trends in cesarean birth to estimate average annual percentage change in rate for this mode of delivery throughout the 20-year period.

The primary outcomes were cesarean birth risk and cesarean deliveries for nonreassuring fetal status and labor arrest.

Overall, cesarean deliveries among those at low risk for cesarean delivery increased from 9.7% in 2000 to 13.9% in 2009. The rate then plateaued before decreasing from 13% in 2012 to 11.1% in 2019, researchers reported. The average annual percentage change for cesarean delivery was 6.4% from 2000 to 2005, 1.2% from 2005 to 2009 and –2.2% from 2009 to 2019.

Researchers observed an increase in cesarean delivery for nonreassuring fetal status, from 3.4% in 2000 to 5.1% in 2019, with an average annual percentage change of 2.1%. There was also an increase in cesarean delivery for labor arrest, from 3.6% in 2000 to 4.8% in 2009, before decreasing to 2.7% in 2019.

From 2000 to 2019, cesarean deliveries for labor arrest increased from 1.5% to 2.1% for the active phase, 1.1% to 1.5% for the latent phase and 0.9% to 1.3% for the second stage, according to the data. In addition, cesarean deliveries for labor arrest decreased from 2.1% to 1.7% from 2010 to 2019 for the active phase, 1.5% to 1.2% for the latent phase and 1.2% to 0.9% for the second stage.

“These findings suggest countervailing trends, with changes in labor abnormality definitions resulting in decreased cesarean delivery and changes in intrapartum fetal tracing categorization resulting in increased cesarean delivery rates,” the researchers wrote. “Future reductions in cesarean deliveries among patients at low risk for cesarean delivery may be dependent on improved assessment of intrapartum fetal status.”