Table 4.
Use of labor management strategies to reduce cesarean deliveries in nulliparous cohort by maternal race and ethnicity
| Non- Hispanic white |
Non-Hispanic Black | Asian | Hispanic | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| N (%) | N (%) | Unadjuste d OR (95%CI) |
aOR (95% CI)* |
N (%) | Unadjusted OR (95%CI) |
aOR (95% CI)* |
N (%) | Unadjusted OR (95%CI) |
aOR (95% CI)* |
|
| Cesarean performed for failed induction prior to 5cm dilation and prior to 12 hours of oxytocin or rupture of membranes (whichever came last)† | 357 (80.6) | 150 (75.8) | 0.75 (0.50–1.13) | 1.02 (0.61–1.72) | 43 (89.6) | 2.07 (0.80–5.39) | 1.06 (0.35–3.19) | 119 (78.8) | 0.90 (0.57–1.41) | 1.35 (0.69–2.63) |
| Labor induction with an unfavorable cervix and without cervical ripening‡ | 212 (21.2) | 147 (18.5) | 1.18 (0.93–1.49) | 0.99 (0.72–1.37) | 32 (19.5) | 1.11 (0.73–1.68) | 1.08 (0.67–1.76) | 86 (18.0) | 1.23 (0.93–1.62) | 0.98 (0.68–1.40) |
| Cesarean performed for arrest of dilation after reaching 5 cm dilatation and prior to 4 hours of dystocia § | 309 (26.0) | 135 (23.4) | 0.87 (0.69–1.10) | 0.79 (0.60–1.05) | 43 (23.1) | 0.86 (0.60–1.24) | 0.76 (0.51–1.13) | 105 (19.7) | 0.70 (0.55–0.90) | 0.67 (0.49–0.92) |
| Cesarean performed for arrest of descent after reaching complete dilation and prior to 3 hours of second stage ‖ | 464 (54.9) | 71 (60.2) | 1.24 (0.84–1.84) | 1.09 (0.69–1.72) | 94 (57.3) | 1.10 (0.79–1.55) | 1.25 (0.85–1.86) | 139 (55.2) | 1.01 (0.76–1.34) | 1.26 (0.87–1.83) |
| Cesarean for NRFS and Apgar score at 1 minute ≥7¶ | 890 (80.5) | 749 (79.3) | 0.93 (0.75–1.15) | 0.88 (0.67–1.16) | 175 (89.3) | 2.01 (1.25–3.24) | 1.79 (1.07–3.00) | 394 (80.1) | 0.97 (0.74–1.27) | 1.05 (0.76–1.45) |
| Composite, any# | 2179 (49.6) | 1219 (51.7) | 1.09 (0.98–1.20) | 1.08 (0.96–1.23) | 379 (52.2) | 1.11 (0.95–1.30) | 1.04 (0.88–1.24) | 822 (46.1) | 0.87 (0.78–0.97) | 0.91 (0.80–1.04) |
aOR, adjusted odds ratio; CI, confidence interval; NRFS, non-reassuring fetal status
Multivariable logistic regression. Compared with non-Hispanic white women. Adjusted for age, BMI, diabetes, smoking, chorioamnionitis, gestational hypertension or preeclampsia, gestational age at delivery, and hospital.
In patients who were induced, received oxytocin, did not reach 5 cm dilation, and underwent cesarean for an indication of failed induction (n=908; n=831 with complete covariable data).
In patients who were induced and had an unfavorable cervix (modified Bishop score <5) (n=2436; n=2403 with complete covariable data).
In patients with who reached 5 cm dilation but did not reach complete dilation, and underwent cesarean for an indication of arrest of dilation (n=2667; n=2466 with complete covariable data).
In patients with who reached complete dilation, and underwent cesarean for an indication of arrest of descent (n=1533; n=1359 with complete covariable data).
In patients who underwent cesarean for an indication of non-reassuring fetal status (n=2739; n=2699 with complete covariable data).
Of the strategies that the patient was eligible for, patient received one or more strategies considered non-use of labor management strategies to reduce cesarean deliveries (cesarean performed for failed induction prior to 5cm dilation and prior to 12 hours of oxytocin and rupture of membranes, labor induction without cervical ripening in women with an unfavorable cervix, cesarean performed for arrest of dilation prior to 4 hours of dystocia after reaching 5 cm dilatation, cesarean performed for arrest of descent prior to 3 hours of second stage, cesarean for NRFS with Apgar score at 1 minute ≥7).