Table 4.
Indications and Timing of Cesarean Delivery by Maternal Age Categories*
| Younger Than 20.0 y (n = 4,094) | 20.0–24.9 y (n = 11,961) | 25.0–29.9 y (n = 14,874) | 30.0–34.9 y (n = 14,497) | 35.0–39.9 y (n = 9,484) | 40.0–44.9 y (n = 2,774) | 45.0 y or Older (n = 220) | |
|---|---|---|---|---|---|---|---|
| Timing of delivery (n = 57,903) | |||||||
| Primary cesarean delivery† | (n = 3,708) | (n = 8,400) | (n = 8,906) | (n = 7,979) | (n = 5,053) | (n = 1,544) | (n = 130) |
| Prelabor | 611 (16.5) | 1,519 (18.1) | 2,054 (23.1) | 2,275 (28.5) | 1,751 (34.7) | 571 (37.0) | 64 (49.2) |
| After spontaneous labor | 1,444 (38.9) | 3,220 (38.3) | 3,250 (36.5) | 2,548 (31.9) | 1,432 (28.3) | 389 (25.2) | 19 (14.6) |
| After induced labor | 1,653 (44.6) | 3,661 (43.6) | 3,602 (40.4) | 3,156 (39.6) | 1,870 (37.0) | 584 (37.8) | 47 (36.2) |
| Repeat cesarean delivery† | (n = 385) | (n = 3,561) | (n = 5,968) | (n = 6,518) | (n = 4,431) | (n = 1,230) | (n = 90) |
| Prelabor | 241 (62.6) | 2,224 (62.5) | 3,423 (57.4) | 4,096 (62.8) | 3,093 (69.8) | 887 (72.1) | 69 (76.7) |
| After spontaneous labor | 122 (31.7) | 1,148 (32.2) | 2,248 (37.7) | 2,108 (32.3) | 1,111 (25.1) | 276 (22.4) | 18 (20.0) |
| After induced labor | 22 (5.7) | 189 (5.3) | 297 (5.0) | 314 (4.8) | 227 (5.1) | 67 (5.5) | 3 (3.3) |
| Indications for cesarean delivery* (n = 53,947) (missing data = 3,956) | (n = 3,856) | (n = 11,303) | (n = 13,845) | (n = 13,342) | (n = 8,791) | (n = 2,602) | (n = 208) |
| Previous uterine scar† | 284 (7.4) | 2,695 (23.8) | 4,772 (34.5) | 5,020 (37.6) | 3,491 (39.7) | 951 (36.6) | 75 (36.1) |
| Failure to progress or cephalopelvic disproportion† | 1,427 (37.0) | 3,510 (31.1) | 3,463 (25.0) | 2,808 (21.1) | 1,488 (16.9) | 430 (16.5) | 29 (13.9) |
| Malpresentation | 791 (20.5) | 2,163 (19.1) | 2,734 (19.8) | 2,706 (20.3) | 1,759 (20.0) | 515 (19.8) | 50 (24.0) |
| Nonreassuring fetal heart tracing† | 1,107 (28.7) | 2,395 (21.2) | 2,235 (16.1) | 1,987 (14.9) | 1,306 (14.9) | 435 (16.7) | 37 (17.8) |
| Elective† | 326 (8.5) | 1,296 (11.5) | 1,637 (11.8) | 1,907 (14.3) | 1,538 (17.5) | 486 (18.7) | 38 (18.3) |
| Hypertensive disease† | 146 (3.8) | 289 (2.6) | 341 (2.5) | 362 (2.7) | 254 (2.9) | 83 (3.2) | 13 (6.3) |
| Macrosomia† | 50 (1.3) | 204 (1.8) | 325 (2.4) | 348 (2.6) | 253 (2.9) | 71 (2.7) | 4 (1.9) |
| Fetal indication or anomaly | 72 (1.9) | 178 (1.6) | 204 (1.5) | 198 (1.5) | 116 (1.3) | 34 (1.3) | 2 (1.0) |
| Failed induction† | 84 (2.2) | 192 (1.7) | 161 (1.2) | 135 (1.0) | 75 (0.9) | 21 (0.8) | 2 (1.0) |
| Placenta previa or vasa previa† | 11 (0.3) | 73 (0.7) | 135 (1.0) | 194 (1.5) | 158 (1.8) | 58 (2.2) | 5 (2.4) |
| Chorioamnionitis† | 44 (1.1) | 107 (1.0) | 97 (0.7) | 66 (0.5) | 41 (0.5) | 16 (0.6) | 0 |
| HIV, active herpes simples virus lesions† | 63 (1.6) | 112 (1.0) | 89 (0.6) | 87 (0.7) | 65 (0.7) | 15 (0.6) | 3 (1.4) |
| Placental abruption‡ | 43 (1.1) | 88 (0.8) | 87 (0.6) | 89 (0.7) | 67 (0.8) | 15 (0.6) | 3 (1.4) |
| Emergency | 21 (0.5) | 34 (0.3) | 55 (0.4) | 45 (0.3) | 38 (0.4) | 11 (0.4) | 0 |
| Failed trial of forceps or vacuum§ | 16 (0.4) | 27 (0.2) | 25 (0.2) | 26 (0.2) | 8 (0.1) | 6 (0.2) | 1 (0.5) |
| History of shoulder dystocia | 0 | 2 (0.02) | 13 (0.09) | 10 (0.07) | 6 (0.07) | 1 (0.04) | 0 |
| Failed VBAC | 1 (0.03) | 7 (0.06) | 7 (0.05) | 13 (0.10) | 6 (0.07) | 1 (0.04) | 0 |
| Shoulder dystocia | 0 | 3 (0.03) | 5 (0.04) | 7 (0.05) | 0 | 0 | 0 |
| Other or unknown† | 266 (6.9) | 639 (5.7) | 745 (5.4) | 772 (5.8) | 580 (6.6) | 221 (8.5) | 19 (9.1) |
| Hierarchical indication groups†∥ (n = 53,947, missing data = 3,956) | (n = 3,856) | (n = 11,303) | (n = 13,845) | (n = 13,342) | (n = 8,791) | (n = 2,602) | (n = 208) |
| Clinically indicated | 1,726 (44.8), referent | 3,916 (34.7), referent | 3,922 (28.3), referent | 3,568 (26.7), referent | 2,224 (25.3), referent | 675 (25.9), referent | 51 (24.5), referent |
| Mixed | 1,644 (42.6) | 6,127 (54.2) | 8,371 (60.5) | 8,133 (61.0) | 5,319 (60.5) | 1,486 (57.1) | 115 (55.3) |
| OR | 0.94 | 0.96 | Referent | 0.99 | 1.03 | 1.02 | 1.03 |
| 99% CI | 0.83–1.08 | 0.87–1.05 | 0.90–1.08 | 0.93–1.15 | 0.87–1.21 | 0.61–1.75 | |
| Truly elective | 486 (12.6) | 1,260 (11.2) | 1,552 (11.2) | 1,641 (12.3) | 1,248 (14.2) | 441 (17.0) | 42 (20.2) |
| OR | 0.97 | 1.01 | Referent | 1.04 | 1.23 | 1.47 | 1.85 |
| 99% CI | 0.81–1.17 | 0.89–1.15 | 0.93–1.18 | 1.08–1.42 | 1.21–1.80 | 1.03–3.32 |
HIV, human immunodeficiency virus; VBAC, vaginal birth after cesarean delivery; OR, odds ratio; CI, confidence interval.
Data are n (%) unless otherwise specified.
*
Because more than one indication could have been listed, indications may add up to more than 100%.
†
P<.001.
‡
P=.037.
§
P=.01.
∥
Adjusted for maternal race, parity, body mass index, insurance type, pre-existing medical conditions, substance abuse, tobacco use, and reporting clinical site. The group aged 25.0–29.9 years was used as the referent category. Missing data for logistic regression = 10,650.