Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Jul;122(1):33-40.
doi: 10.1097/AOG.0b013e3182952242.

Primary cesarean delivery in the United States

Annelee Boyle  1 , Uma M Reddy, Helain J Landy, Chun-Chih Huang, Rita W Driggers, S Katherine Laughon
Affiliations

Primary cesarean delivery in the United States

Annelee Boyle et al. Obstet Gynecol. 2013 Jul.

Abstract

Objectives: To characterize the indications for primary cesarean delivery in a large national cohort and to identify opportunities to lower the U.S. primary cesarean delivery rate.

Methods: A retrospective cohort study of the 38,484 primary cesarean deliveries among the 228,562 deliveries at sites participating in the Consortium on Safe Labor from 2002 to 2008.

Results: The primary cesarean delivery rate was 30.8% for primiparous women and 11.5% for multiparous women. The most common indications for primary cesarean delivery were failure to progress (35.4%), nonreassuring fetal heart rate tracing (27.3%), and fetal malpresentation (18.5%), although frequencies for each indication varied by parity. Among women with failure to progress, 42.6% of primiparous women and 33.5% of multiparous women never progressed beyond 5 cm of dilation before delivery. Among women who reached the second stage of labor, 17.3% underwent cesarean delivery for arrest of descent before 2 hours and only 1.1% were given a trial of operative vaginal delivery. Of all primary cesarean deliveries, 45.6% were performed on primiparous women at term with a singleton fetus in cephalic presentation.

Conclusion: Using 6 cm as the cut-off for active labor, allowing adequate time for the second stage of labor, and encouraging operative vaginal delivery, when appropriate, may be important strategies to reduce the primary cesarean delivery rate. These actions may be particularly important in the primiparous woman at term with a singleton fetus in cephalic presentation.

Level of evidence: III.

PubMed Disclaimer

References

    1. Hall MJ, DeFrances CJ, Williams SN, Golosinskiy AG, Schwartzman A. National Hospital Discharge Survey: 2007 Summary. Natl Vital Stat Report. 2010;29:1–24. - PubMed
    1. Martin JA, Hamilton BE, Ventura SJ, Osterman MJK, Kirmeyer S, Mathews TJ, et al. Births: Final Data for 2009. Natl Vital Stat Report. 2011;60(1):1–35. - PubMed
    1. Organisation for Economic Co-operation and Development. OECD Health Data 2011 –Frequently Requested Data. Available at: http://www.oecd.org/document/16/0,3746,en_2649_33929_2085200_1_1_1_1,00....Retrieved February 28, 2012.
    1. Brown HL. Informing the patient and the community about the implications of primary cesarean. Semin Perinatol. 2012;36:403–6. - PubMed
    1. Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107:1226–32. - PubMed

Publication types