Table 2. Cumulative Risk of Primary Cesarean Delivery by Indication from 2003 to 2009.
Primary cesarean rates for each indication per 1000 eligible live births from 2003 to 2009 (adjusted for repeat cesarean rate)*
| 2003 n = 4327 |
2004 n = 4135 |
2005 n = 4128 |
2006 n = 4137 |
2007 n = 3928 |
2008 n = 3845 |
2009 n = 3737 |
Absolute Increase 2003–2009 (crude)† | Mean Annual Increase (95% CI)‡ | Cumulative Annualized Relative Increase (95% CI) § | |
|---|---|---|---|---|---|---|---|---|---|---|
| All Primary Cesareans | 181.2 | 215.0 | 237.9 | 258.2 | 237.0 | 245.8 | 254.7 | 73.6 | 6.0% (4.5, 7.4) | 1.50 (1.36, 1.65) |
| Labor Arrest Disorders | 68.6 | 88.8 | 92.3 | 97.7 | 90.9 | 90.3 | 87.0 | 18.3 | 2.7% (0.6, 4.9) | 1.21 (1.04, 1.40) |
| Arrest of dilation | 43.9 | 61.4 | 63.5 | 66.5 | 59.3 | 63.7 | 63.2 | 19.2 | 3.9% (1.4, 6.5) | 1.31 (1.10, 1.55) |
| Arrest of descent | 24.7 | 27.3 | 28.8 | 31.2 | 31.6 | 26.5 | 23.8 | –0.91 | 0% (–0.04, 3.6) | 1.00 (0.78, 1.28) |
| Macrosomia¶ | 3.2 | 5.1 | 16.0 | 13.5 | 12.5 | 10.4 | 11.2 | 8.0 | 12.3% (5.9, 19.1) | 2.25 (1.49, 3.40) |
| Malpresentation# | 42.5 | 40.4 | 32.2 | 29.5 | 32.3 | 28.6 | 42.0 | –0.5 | –2.8% (–5.9, 0.3) | 0.82 (0.65, 1.02) |
| Maternal-Fetal** | 8.3 | 11.4 | 13.8 | 13.8 | 9.7 | 13.0 | 13.4 | 5.1 | 4.6% (–0.9, 10.4) | 1.37 (0.94, 2.00) |
| Maternal Request|| | 1.4 | 4.1 | 1.7 | 2.7 | 3.3 | 7.5 | 7.0 | 5.6 | 27.0% (14.9, 40.3) | 5.32 (2.64, 10.70) |
| Multiple gestation | 5.1 | 6.0 | 14.1 | 16.0 | 11.5 | 14.8 | 16.3 | 11.2 | 16.5% (10.2, 23.1) | 2.91 (1.97, 4.28) |
| NRFHT | 40.0 | 47.9 | 49.7 | 66.5 | 58.0 | 63.7 | 58.9 | 18.9 | 7.1% (4.4, 9.9) | 1.62 (1.35, 1.94) |
| Other Obstetric Indications†† | 9.2 | 7.7 | 12.8 | 10.9 | 10.4 | 9.4 | 10.2 | 0.9 | 1.4% (–4.3%, 7.5) | 1.10 (0.74, 1.66) |
| Preeclampsia‡‡ | 2.8 | 3.6 | 5.3 | 7.7 | 8.4 | 8.1 | 8.8 | 6.1 | 19.2% (10.5, 28.7) | 3.44 (2.01, 5.85) |
NRFHT, non-reassuring fetal heart tracing
Eligible live births are defined as births at risk for primary cesarean section; all repeat cesarean sections excluded from analysis
Rate in 2009 – rate in 2003 per 1000 eligible live births
Estimated mean annual increase calculated by logistic regression using data from all years, 2003–2009
Cumulative annualized relative increase (2003–2009) calculated by logistic regression, compounding the estimated annual increase over 7 years
Without other documented medical indications
Suspected macrosomia based on ultrasound or clinical estimate
Any non-cephalic presentation
Maternal conditions predating the pregnancy or fetal antenatal problems, such as fetal anomalies, which could preclude vaginal delivery
Conditions brought about by the presence of the current intrauterine pregnancy: placental abruption, accreta, and previa, cord prolapse, cerclage, and chorioamnionitis
Pre-eclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzymes and low platelet) syndrome