Grand Rounds

Do Cesarean Delivery Rates Impact Neonatal Morbidity?

BACKGROUND AND PURPOSE:

Some studies suggest that caesarean target rates should fall between 10 to 20%
Clapp et al. (BJOG, 2021) examined the association between county-level cesarean delivery rates among low-risk women and morbidity among term newborns

Cross-sectional study
Population
- Nulliparous women with term, singleton, vertex-presenting infants (NTSV) at low risk for morbidity
Exposure
- County-level cesarean rates
Study design
- Linear regression models were used to determine the association between county NTSV cesarean rates and neonatal morbidity rates
Primary outcome
- Moderate or severe morbidity
  - Moderate: 5-minute Apgar<7 but >3 | Antibiotic administration | Assisted ventilation at delivery
  - Severe: 5-minute Apgar ≤3 | Assisted ventilation for ≥6 hours | Severe neurologic injury or seizure | Transfer | Death

2,753,522 births | 952 counties | 48 US states
Mean NTSV cesarean delivery rate: 23.6%
- Median severe morbidity: 15.2 (IQR 9.4 to 23.6) per 1,000 births
- Median moderate morbidity: 52.5 (IQR 33.4 to 75.7) per 1,000 births
Every percentage point increase in a county’s CD rate was associated with decrease in neonatal morbidity
- Severe: 0.6 (95% CI, -0.9 to -0.3) fewer cases per 1,000 live births
- Moderate: 2.3 (95% CI, -3.4 to -1.1) fewer cases per 1,000 live births
After adjustment for other confounding factors, the relationships remained significant

Among low-risk nulliparous women, higher NTSV cesarean delivery rates were associated with small decreases in morbidity among term newborns in the US (BJOG)

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