American Journal of Obstetrics & Gynecology
Volume 203, Issue 4 , Pages 326.e1-326.e10, October 2010

Contemporary cesarean delivery practice in the United States

  • Jun Zhang, PhD, MD

      Affiliations

    • Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
    • ,
  • James Troendle, PhD

      Affiliations

    • Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
    • ,
  • Uma M. Reddy, MD, MPH

      Affiliations

    • Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
    • ,
  • S. Katherine Laughon, MD, MS

      Affiliations

    • Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
    • ,
  • D. Ware Branch, MD

      Affiliations

    • Intermountain HealthCare and University of Utah, Salt Lake City, UT
    • ,
  • Ronald Burkman, MD

      Affiliations

    • Baystate Medical Center, Springfield, MA
    • ,
  • Helain J. Landy, MD

      Affiliations

    • Georgetown University Hospital, MedStar Health, Washington, DC
    • ,
  • Judith U. Hibbard, MD

      Affiliations

    • University of Illinois at Chicago, Chicago, IL
    • ,
  • Shoshana Haberman, MD, PhD

      Affiliations

    • Maimonides Medical Center, Brooklyn, NY
    • ,
  • Mildred M. Ramirez, MD

      Affiliations

    • University of Texas Health Science Center at Houston, Houston, TX
    • ,
  • Jennifer L. Bailit, MD, MPH

      Affiliations

    • MetroHealth Medical Center, Cleveland, OH
    • ,
  • Matthew K. Hoffman, MD, MPH

      Affiliations

    • Christiana Care Health System, Wilmington, DE
    • ,
  • Kimberly D. Gregory, MD, MPH

      Affiliations

    • Cedars-Sinai Medical Center, Los Angeles, CA
    • ,
  • Victor H. Gonzalez-Quintero, MD, MPH

      Affiliations

    • University of Miami, Miami, FL
    • ,
  • Michelle Kominiarek, MD

      Affiliations

    • Indiana University–Clarian Health, Indianapolis, IN
    • ,
  • Lee A. Learman, MD, PhD

      Affiliations

    • Indiana University–Clarian Health, Indianapolis, IN
    • ,
  • Christos G. Hatjis, MD

      Affiliations

    • Summa Health System, Akron City Hospital, Akron, OH
    • ,
  • Paul van Veldhuisen, PhD

      Affiliations

    • The EMMES Corporation, Rockville, MD
    • ,
  • Consortium on Safe Labor

Received 6 April 2010; received in revised form 31 May 2010; accepted 21 June 2010. published online 13 August 2010.

Objective

To describe contemporary cesarean delivery practice in the United States.

Study Design

Consortium on Safe Labor collected detailed labor and delivery information from 228,668 electronic medical records from 19 hospitals across the United States, 2002-2008.

Results

The overall cesarean delivery rate was 30.5%. The 31.2% of nulliparous women were delivered by cesarean section. Prelabor repeat cesarean delivery due to a previous uterine scar contributed 30.9% of all cesarean sections. The 28.8% of women with a uterine scar had a trial of labor and the success rate was 57.1%. The 43.8% women attempting vaginal delivery had induction. Half of cesarean for dystocia in induced labor were performed before 6 cm of cervical dilation.

Conclusion

To decrease cesarean delivery rate in the United States, reducing primary cesarean delivery is the key. Increasing vaginal birth after previous cesarean rate is urgently needed. Cesarean section for dystocia should be avoided before the active phase is established, particularly in nulliparous women and in induced labor.

Key words: cesarean delivery, induction, labor, vaginal birth after previous cesarean

 

 The Consortium on Safe Labor was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, through Contract no. HHSN267200603425C.

 Reprints not available from the authors.

 Cite this article as: Zhang J, Troendle J, Reddy UM, et al, for the Consortium on Safe Labor. Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol 2010;203:326.e1-10.

PII: S0002-9378(10)00838-0

doi:10.1016/j.ajog.2010.06.058

American Journal of Obstetrics & Gynecology
Volume 203, Issue 4 , Pages 326.e1-326.e10, October 2010

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