Temporal trends of cesarean delivery on maternal request in the United States, 2016-2019.

ABSTRACT

OBJECTIVE: Cesarean delivery on maternal request (elective-CD) increased between 1999 and 2015 in the United States, but multiple studies have reported the association between elective-CD and adverse maternal and neonatal outcomes. More contemporary trends and outcomes are currently unknown. The objective of the current study was to examine contemporaneous trends and outcomes of patients who had elective-CD in the United States. METHODS: This is a retrospective cohort study querying the Healthcare Cost and Utilization Project's National Inpatient Sample from January 2016 to December 2019. A three-step exclusion approach was used to identify the surrogate for elective-CD (prior uterine scar, maternal / fetal indications for CD, and labor). The primary outcome was temporal trend of elective-CD. The secondary outcomes included severe maternal morbidity in low-risk vaginal delivery candidates, assessed with inverse probability of treatment weighting propensity score. RESULTS: Among 14,648,135 all deliveries for national estimates, 184,945 (1.26 %) patients had elective-CD. The number of patients undergoing elective-CD decreased from 1.35 % to 1.13 % among all deliveries (16.3 % relative-decrease; P-trend < 0.001) and from 4.14 % to 3.51 % among all CD cases (15.2 % relative-decrease, P-trend = 0.002) between QT1/2016 and QT4/2019. The decreasing trend of elective-CD remained independent in multivariable analysis: odds ratio (OR) compared to 2016, 0.96 (95 % confidence interval [CI] 0.95-0.97) for 2017, 0.94 (95 %CI 0.93-0.95) for 2018, and 0.87 (95 %CI 0.86-0.89) for 2019. In a propensity score weighted model among low-risk vaginal delivery candidates, patients in the elective-CD group were more likely to have severe maternal morbidity compared to those in the non-elective-CD group (OR 2.01, 95 %CI 1.87-2.15). CONCLUSIONS: This national-level analysis suggests that the number of elective-CD is gradually decreasing in recent years in the United States.