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- W2054025705 abstract "The cesarean delivery rate has been steadily increasing since 1996 and in 2007 was the highest ever recorded at 32%. We examined physician-documented indications for cesarean section in order to investigate which specific indications have contributed to the increase. We examined rates of cesarean section, including primary cesarean section and indications, repeat cesarean section, and vaginal birth after cesarean at Yale New Haven Hospital for all births (n=64,012) between July 1996-February 2010. Linear regression was used to estimate time trends for each indication and slopes were compared to determine the relative contribution of each indication to the overall increase. The overall cesarean section rate increased drastically between 1997 and 2009 (19.6% to 36.5%) as did the primary cesarean rate (13.4% to 21.7%) and the repeat cesarean rate (6.25% to 14.9%). Meanwhile, VBAC rates plummeted from 42.5% to 7.8%. The rate of cesarean section for private patients was higher and rose more quickly than the rate for hospital service patients. The number of cesareans performed for all indications increased with the exception of malpresentation. The relative contribution of each indication to the total increase in the primary cesarean rate are: Non-reassuring fetal status (30%), arrest of labor disorders (20%), multiple gestation (16%), macrosomia (10%), pre-eclampsia (10%), elective per patient request (8%), maternal-fetal conditions (5%), and obstetric conditions (1%). Among primary cesarean births, all indications for the procedure contributed to the increasing rate, with more subjective indications (labor arrest disorders, non-reassuring fetal heart rate tracings, and macrosomia) contributing larger proportions than more objective indications with long-standing definitions (malpresentation and other obstetric conditions, e.g. placenta previa, accreta, cord prolapse, chorioamnionitis). Efforts to address the rising cesarean rate may benefit from attempts to convert subjective indications into objective ones though stronger and clearer evidence-based guidelines." @default.
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- W2054025705 date "2011-01-01" @default.
- W2054025705 modified "2023-09-27" @default.
- W2054025705 title "670: Contributing indications to the increasing cesarean delivery rate" @default.
- W2054025705 doi "https://doi.org/10.1016/j.ajog.2010.10.690" @default.
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