title: Repeat cesareans: how many are elective?
abstract: OBJECTIVE
  To describe the clinical indications for repeat cesarean delivery and to compare these with indications for primary procedures.
  
  
  METHODS
  We reviewed cesarean deliveries at our academic nonprofit hospital during 1992 (n = 1885). The indication for the procedure was abstracted based on surgeon operative reports and discharge ICD-9 codes (International Classification of Diseases, Clinical Modification, 9th Edition).
  
  
  RESULTS
  The hospital cesarean rate was 28.7%; 34% of these were repeat procedures (n = 643). Elective cesarean delivery was the leading cause of repeat cesareans, followed by "other" indications, dystocia, breech, and fetal distress. In contrast, dystocia was the leading cause for primary cesarean, followed by fetal distress, "other," and breech presentation. One hundred women (15.6%) undergoing repeat cesarean had absolute or relative contraindications to a trial of labor.
  
  
  CONCLUSIONS
  Indications for cesareans using hierarchies based on ICD-9 codes do not attempt to differentiate categories of indications for repeat cesarean. Current recommendations for lowering cesarean rates by increasing vaginal birth after previous cesarean are based on aggregate data and do not recognize that some repeat cesareans are clinically indicated. A coding system designed to distinguish elective from indicated repeat cesareans would be useful for future prospective studies.
authors.affiliation: Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, California.
authors.forename: K D
authors.initials: KD
authors.lastname: Gregory
authors.forename: O A
authors.initials: OA
authors.lastname: Henry
authors.forename: A J
authors.initials: AJ
authors.lastname: Gellens
authors.forename: C J
authors.initials: CJ
authors.lastname: Hobel
authors.forename: L D
authors.initials: LD
authors.lastname: Platt
mesh_terms: D000328:Adult; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery; D012189:Retrospective Studies