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Elective primary cesarean delivery rates show a rising trend

Rates for elective primary cesarean deliveries (first-time cesarean deliveries which occur before a woman goes into labor) rose nearly 44 percent from 1994 to 2001. This increase included a rise in the number of elective primary cesarean deliveries for which there was no clear medical or obstetric indication, according to a study by Susan F. Meikle, M.D., M.S.P.H., of the Agency for Healthcare Research and Quality, and colleagues.

Using data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, the researchers found that elective primary cesarean deliveries rose from 19.7 percent of all cesarean deliveries in 1994 to 28.3 percent in 2001. Some indications (based on diagnostic codes) for the procedure also shifted during this time. Use of the procedure increased for malpresentation of the fetus, antepartum bleeding, maternal hypertension and severe hypertension, macrosomia (excessive birth weight), unengaged fetal head, preterm gestation, and maternal soft tissue disorder. Use of the procedure for maternal herpes, multiple gestation, other uterine scar, and congenital central nervous system remained the same.

The main cause for the rise in overall total of elective cesarean procedures was the use of a new code for fetal heart rate abnormalities, which was rapidly adopted from 1998 to 2001. Fetal heart rate abnormalities accounted for 16.8 percent of elective primary cesarean deliveries in 2001. Researchers note, however, that the reasons for the increase in the use of the fetal heart rate abnormality code are uncertain.

See "A national estimate of the elective primary cesarean delivery rate," by Dr. Meikle, Claudia A. Steiner, M.D., M.P.H., Jun Zang, M.D., and William L. Lawrence, M.D., M.S., in the April 2005 Obstetrics & Gynecology 105(4), p. 751-756. Reprints (AHRQ Publication No. 05-R056) are available from the AHRQ Publications Clearinghouse.

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