Predictors of cesarean delivery for periviable neonates

Brownsne Tucker Edmonds, Corinne Fager, Sindhu Srinivas, Scott Lorch

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective: To test for racial or ethnic disparities or both in periviable cesarean delivery and describe sociodemographic and clinical characteristics associated with periviable cesarean delivery. Methods: This was a retrospective cohort study of state-level maternal and neonatal hospital discharge data linked to vital statistics data for deliveries occurring between 23.0 and 24.6 weeks of gestation in California, Missouri, and Pennsylvania from 1995 to 2005 (N=8,290). Results: Approximately 79% of the population was aged 18-35 years, and almost half were nulliparous. Almost 20% of the women were African American, 36.4% were Hispanic, and 33.6% were white. Overall, 33.6% of periviable neonates were delivered by cesarean. In multivariable analyses adjusting for sociodemographic and clinical characteristics, cesarean delivery did not differ among African American and Hispanic women compared with white women (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.76-1.05; and OR 0.95, 95% CI 0.83-1.09, respectively). Women presenting with preterm labor were significantly less likely to undergo cesarean delivery (OR 0.84, 95% CI 0.73-0.96), whereas women presenting with preterm premature rupture of membranes (OR 1.29, 95% CI 1.14-1.45) or abruption (OR 2.43, 95% CI 2.09-2.81) were more likely to have cesarean deliveries. The strongest predictor of periviable cesarean delivery was pregnancy-induced hypertension (OR 15.6.4, 95% CI 12.3-19.7). Conclusion: Unlike disparities observed at later gestational ages, cesarean delivery did not differ by race and ethnicity among this periviable cohort. Instead, medical indications such as pregnancy-induced hypertension, preterm premature rupture of membranes, or abruption were associated with a higher likelihood of cesarean delivery. Periviable deliveries represent a subset of deliveries, wherein race and ethnicity do not influence mode of delivery; the acuity of the clinical encounter dictates the course of care.

Original languageEnglish (US)
Pages (from-to)49-56
Number of pages8
JournalObstetrics and Gynecology
Volume118
Issue number1
DOIs
StatePublished - Jul 2011
Externally publishedYes

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Odds Ratio
Newborn Infant
Confidence Intervals
Pregnancy Induced Hypertension
Hispanic Americans
African Americans
Vital Statistics
Premature Obstetric Labor
Gestational Age
Cohort Studies
Retrospective Studies
Mothers
Pregnancy
Population
Preterm Premature Rupture of the Membranes

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Predictors of cesarean delivery for periviable neonates. / Tucker Edmonds, Brownsne; Fager, Corinne; Srinivas, Sindhu; Lorch, Scott.

In: Obstetrics and Gynecology, Vol. 118, No. 1, 07.2011, p. 49-56.

Research output: Contribution to journalArticle

Tucker Edmonds, Brownsne ; Fager, Corinne ; Srinivas, Sindhu ; Lorch, Scott. / Predictors of cesarean delivery for periviable neonates. In: Obstetrics and Gynecology. 2011 ; Vol. 118, No. 1. pp. 49-56.
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abstract = "Objective: To test for racial or ethnic disparities or both in periviable cesarean delivery and describe sociodemographic and clinical characteristics associated with periviable cesarean delivery. Methods: This was a retrospective cohort study of state-level maternal and neonatal hospital discharge data linked to vital statistics data for deliveries occurring between 23.0 and 24.6 weeks of gestation in California, Missouri, and Pennsylvania from 1995 to 2005 (N=8,290). Results: Approximately 79{\%} of the population was aged 18-35 years, and almost half were nulliparous. Almost 20{\%} of the women were African American, 36.4{\%} were Hispanic, and 33.6{\%} were white. Overall, 33.6{\%} of periviable neonates were delivered by cesarean. In multivariable analyses adjusting for sociodemographic and clinical characteristics, cesarean delivery did not differ among African American and Hispanic women compared with white women (odds ratio [OR] 0.89, 95{\%} confidence interval [CI] 0.76-1.05; and OR 0.95, 95{\%} CI 0.83-1.09, respectively). Women presenting with preterm labor were significantly less likely to undergo cesarean delivery (OR 0.84, 95{\%} CI 0.73-0.96), whereas women presenting with preterm premature rupture of membranes (OR 1.29, 95{\%} CI 1.14-1.45) or abruption (OR 2.43, 95{\%} CI 2.09-2.81) were more likely to have cesarean deliveries. The strongest predictor of periviable cesarean delivery was pregnancy-induced hypertension (OR 15.6.4, 95{\%} CI 12.3-19.7). Conclusion: Unlike disparities observed at later gestational ages, cesarean delivery did not differ by race and ethnicity among this periviable cohort. Instead, medical indications such as pregnancy-induced hypertension, preterm premature rupture of membranes, or abruption were associated with a higher likelihood of cesarean delivery. Periviable deliveries represent a subset of deliveries, wherein race and ethnicity do not influence mode of delivery; the acuity of the clinical encounter dictates the course of care.",
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N2 - Objective: To test for racial or ethnic disparities or both in periviable cesarean delivery and describe sociodemographic and clinical characteristics associated with periviable cesarean delivery. Methods: This was a retrospective cohort study of state-level maternal and neonatal hospital discharge data linked to vital statistics data for deliveries occurring between 23.0 and 24.6 weeks of gestation in California, Missouri, and Pennsylvania from 1995 to 2005 (N=8,290). Results: Approximately 79% of the population was aged 18-35 years, and almost half were nulliparous. Almost 20% of the women were African American, 36.4% were Hispanic, and 33.6% were white. Overall, 33.6% of periviable neonates were delivered by cesarean. In multivariable analyses adjusting for sociodemographic and clinical characteristics, cesarean delivery did not differ among African American and Hispanic women compared with white women (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.76-1.05; and OR 0.95, 95% CI 0.83-1.09, respectively). Women presenting with preterm labor were significantly less likely to undergo cesarean delivery (OR 0.84, 95% CI 0.73-0.96), whereas women presenting with preterm premature rupture of membranes (OR 1.29, 95% CI 1.14-1.45) or abruption (OR 2.43, 95% CI 2.09-2.81) were more likely to have cesarean deliveries. The strongest predictor of periviable cesarean delivery was pregnancy-induced hypertension (OR 15.6.4, 95% CI 12.3-19.7). Conclusion: Unlike disparities observed at later gestational ages, cesarean delivery did not differ by race and ethnicity among this periviable cohort. Instead, medical indications such as pregnancy-induced hypertension, preterm premature rupture of membranes, or abruption were associated with a higher likelihood of cesarean delivery. Periviable deliveries represent a subset of deliveries, wherein race and ethnicity do not influence mode of delivery; the acuity of the clinical encounter dictates the course of care.

AB - Objective: To test for racial or ethnic disparities or both in periviable cesarean delivery and describe sociodemographic and clinical characteristics associated with periviable cesarean delivery. Methods: This was a retrospective cohort study of state-level maternal and neonatal hospital discharge data linked to vital statistics data for deliveries occurring between 23.0 and 24.6 weeks of gestation in California, Missouri, and Pennsylvania from 1995 to 2005 (N=8,290). Results: Approximately 79% of the population was aged 18-35 years, and almost half were nulliparous. Almost 20% of the women were African American, 36.4% were Hispanic, and 33.6% were white. Overall, 33.6% of periviable neonates were delivered by cesarean. In multivariable analyses adjusting for sociodemographic and clinical characteristics, cesarean delivery did not differ among African American and Hispanic women compared with white women (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.76-1.05; and OR 0.95, 95% CI 0.83-1.09, respectively). Women presenting with preterm labor were significantly less likely to undergo cesarean delivery (OR 0.84, 95% CI 0.73-0.96), whereas women presenting with preterm premature rupture of membranes (OR 1.29, 95% CI 1.14-1.45) or abruption (OR 2.43, 95% CI 2.09-2.81) were more likely to have cesarean deliveries. The strongest predictor of periviable cesarean delivery was pregnancy-induced hypertension (OR 15.6.4, 95% CI 12.3-19.7). Conclusion: Unlike disparities observed at later gestational ages, cesarean delivery did not differ by race and ethnicity among this periviable cohort. Instead, medical indications such as pregnancy-induced hypertension, preterm premature rupture of membranes, or abruption were associated with a higher likelihood of cesarean delivery. Periviable deliveries represent a subset of deliveries, wherein race and ethnicity do not influence mode of delivery; the acuity of the clinical encounter dictates the course of care.

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