title: Maternal, care provider, and institutional-level risk factors for early term elective repeat cesarean delivery: a population-based cohort study.
abstract: To identify maternal, care provider, and institutional-level risk factors for early term (37-38 weeks) elective repeat cesarean delivery in a population-based cohort. Retrospective cohort study of women in the British Columbia (BC) Perinatal Data Registry, BC, Canada, 2008-2011, with an elective repeat cesarean delivery at term. Absolute percent differences (risk differences) in early term delivery rates were calculated according to maternal characteristics, type of care provider, calendar time (day of the week, time of year), and annual institutional obstetrical volume. Of the 7,687 elective repeat cesareans at term in BC, 55 % occurred before 39 + 0 weeks. Early term delivery was significantly more common with multiple previous cesareans [8.2 percentage points (95 % CI 5.5, 10.9) for 2 previous cesareans, 11.3 (95 % CI 5.1, 17.4) for 3 or more previous cesareans], obesity [6.7 percentage points (95 % CI 1.6, 11.7)], and a hospital obstetrical volume <2,500 deliveries per year. Type of care provider and calendar time were not significant risk factors for early term delivery. Early term elective repeat cesarean was common across a wide range of maternal, care provider, and institutional characteristics, suggesting that most obstetrical care settings would benefit from quality-improvement programs to reduce elective repeat cesarean deliveries before 39 weeks. A better understanding of the risks and benefits of early term delivery among obese women and women with multiple previous cesareans is needed given the higher rates of early term delivery observed in these women.
authors: Department of Obstetrics & Gynaecology, BC Children's & Women's Hospital, University of British Columbia, Shaughnessy E421A, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada. jhutcheon@cfri.ca.|Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, BC, Canada. jhutcheon@cfri.ca.
authors: Jennifer A
authors: JA
authors: Hutcheon
authors: Department of Obstetrics & Gynaecology, BC Children's & Women's Hospital, University of British Columbia, Shaughnessy E421A, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.|Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, BC, Canada.|School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors: K S
authors: KS
authors: Joseph
authors: Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, BC, Canada.
authors: Brooke
authors: B
authors: Kinniburgh
authors: Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, BC, Canada.
authors: Lily
authors: L
authors: Lee
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001955:British Columbia / Q000453:epidemiology; D017604:Cesarean Section, Repeat / Q000592:standards / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006282:Health Personnel / Q000145:classification / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008423:Maternal Age; D009775:Obstetrics and Gynecology Department, Hospital / Q000706:statistics & numerical data*; D018743:Perinatal Care / Q000379:methods / Q000706:statistics & numerical data; D011247:Pregnancy; D012042:Registries; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D000078329:Workforce; D055815:Young Adult
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