Contemporary cesarean delivery practice in the United States.
OBJECTIVE
To describe contemporary cesarean delivery practice in the United States.


METHODS
Consortium on Safe Labor collected detailed labor and delivery information from 228,668 electronic medical records from 19 hospitals across the United States, 2002-2008.


RESULTS
The overall cesarean delivery rate was 30.5%. The 31.2% of nulliparous women were delivered by cesarean section. Prelabor repeat cesarean delivery due to a previous uterine scar contributed 30.9% of all cesarean sections. The 28.8% of women with a uterine scar had a trial of labor and the success rate was 57.1%. The 43.8% women attempting vaginal delivery had induction. Half of cesarean for dystocia in induced labor were performed before 6 cm of cervical dilation.


CONCLUSIONS
To decrease cesarean delivery rate in the United States, reducing primary cesarean delivery is the key. Increasing vaginal birth after previous cesarean rate is urgently needed. Cesarean section for dystocia should be avoided before the active phase is established, particularly in nulliparous women and in induced labor.
Zhang
Jun
J
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
Troendle
James
J
Reddy
Uma M
UM
Laughon
S Katherine
SK
Branch
D Ware
DW
Burkman
Ronald
R
Landy
Helain J
HJ
Hibbard
Judith U
JU
Haberman
Shoshana
S
Ramirez
Mildred M
MM
Bailit
Jennifer L
JL
Hoffman
Matthew K
MK
Gregory
Kimberly D
KD
Gonzalez-Quintero
Victor H
VH
Kominiarek
Michelle
M
Learman
Lee A
LA
Hatjis
Christos G
CG
van Veldhuisen
Paul
P
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data; D002921:Cicatrix / Q000453:epidemiology; D016208:Databases, Factual; D004420:Dystocia / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005316:Fetal Distress / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D007746:Labor Presentation; D007747:Labor Stage, First; D007751:Labor, Induced / Q000706:statistics & numerical data; D008423:Maternal Age; D009765:Obesity / Q000453:epidemiology; D010298:Parity; D011247:Pregnancy; D011272:Pregnancy, Multiple; D014219:Trial of Labor; D014481:United States / Q000453:epidemiology