title: Increased cesarean section rate over time (1994-2006) in Delaware is not associated with improved outcomes in very low birth weight infants.
abstract: Cesarean deliveries (C-section) have been increasing over time. The objectives of this study were to analyze cesarean section delivery rates over time, and determine whether there is an association between C-section, mortality, and severe intraventricular hemorrhage (IVH) in VLBW infants. We performed a retrospective cohort study of babies with birth weight < 1,500 grams, between 1994 and 2006, at Christiana Hospital (n = 2,040). Severe IVH was considered grade 3 to 4. Data were analyzed by three-year cohorts. Statistics included unadjusted and multivariable analyses. Cesarean delivery increased 22 percent from 1994 to 2006. When controlling for potential confounding variables including gestational age and presentation at birth, odds of C-section delivery remained elevated in Cohort 4 (2003-2006) compared with Cohort 1 (1994-1997; OR = 1.12, 95% CI 1.01-1.24). The rate of infant death and severe IVH did not change over time. After multivariable analysis, C-section was not associated with a decrease in death, severe IVH, or death and/or IVH. In our population of VLBW infants, the rate of C-section delivery increased over time. This increased rate was not associated with any change in the odds of death and/or severe IVH.
authors.affiliation: Delaware Department of Health and Social Services, Division of Public Health, Center for Family Health Research and Epidemiology, Dover, DE, USA.
authors.forename: Hashini R
authors.initials: HR
authors.lastname: Seneviratne
authors.forename: Charlan
authors.initials: C
authors.lastname: Kroelinger
authors.forename: David A
authors.initials: DA
authors.lastname: Paul
mesh_terms: D002543:Cerebral Hemorrhage / Q000453:epidemiology; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D015999:Multivariate Analysis; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies