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Grand Rounds

Do Cesarean Delivery Rates Impact Neonatal Morbidity?

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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

METHODS:

  • 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

RESULTS:

  • 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

CONCLUSION:

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

Learn More – Primary Sources:

Association between morbidity among term newborns and low-risk cesarean delivery rates

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Related ObG Topics:

CMQCC Report: Using a Hospital-Level Collaborative to Reduce Cesarean Rates
Does Staffing Impact Cesarean Section Rate?
Induction to Prevent Stillbirths for Age 35 and Older: Impact on Cesarean Rates?

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