Impact of labor induction, gestational age, and maternal age on cesarean delivery rates
Section snippets
Materials and methods
Our sample was collected from Beth Israel Deaconess Medical Center and Brigham and Women’s Hospital in Boston, the two largest obstetric services in the city. The delivery services at each of these two institutions are comprised of a variety of practice models, including resident practices, maternal–fetal medicine services, midwifery services caring for community health center patients and health maintenance organization patients, and conventional private practices staffed by one to six
Results
Overall, the primary cesarean delivery rate in the cohort was 10.8%. The difference in cesarean delivery rates between the two hospitals was a function of different rates of assisted vaginal delivery. The proportions of women in both institutions who delivered spontaneously were virtually identical (80.3% versus 80.0%).
Among the 7372 nulliparous women in the sample, 2227 (30%) had induced labor. Induced nulliparas had a 24.7% cesarean delivery rate, compared with a 13.7% cesarean delivery rate
Discussion
Our study demonstrates that labor induction, parity, maternal age, and birth weight extremes played significant roles in determining risk for cesarean delivery in our cohort of ethnically diverse and relatively low-risk obstetric patients. Women with hypertension and diabetes also had an increased risk for cesarean delivery but did not contribute substantially to the overall cesarean delivery rate because of their low prevalence. Induction was associated with a 70% increase in the risk of
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