title: Cesarean Delivery in Adolescents.
abstract: OBJECTIVE
  To examine the effect of maternal age on indication for primary cesarean delivery in low-risk nulliparous women.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Urban academic tertiary care center.
  
  
  METHODS
  Nulliparous women younger than 35 years of age delivering vertex-presenting singletons at term.
  
  
  METHODS
  Participants underwent spontaneous, operative or cesarean delivery.
  
  
  METHODS
  Mode of delivery, indication, and timing of cesarean delivery.
  
  
  RESULTS
  Adolescents were half as likely to undergo cesarean delivery overall (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.43-0.54), and more than one-third less likely to undergo cesarean delivery in labor (OR, 0.59; 95% CI, 0.53-0.66). Adjustment for potential confounders did not alter the strength of these associations. Adolescents were half as likely to undergo cesarean delivery for failure to progress (OR, 0.49; 95% CI, 0.43-0.54). There was no difference in the odds of cesarean delivery for nonreassuring fetal status (OR, 0.91; 95% CI, 0.77-1.06), or genital herpes (OR, 1.44; 95% CI, 0.57-3.68). Induction, macrosomia, oxytocin augmentation, and any labor complication were all associated with increased risk of cesarean delivery. There was no difference in the duration of second stage for adolescents who delivered by cesarean delivery compared with adults (240.0 vs 237.7 minutes; P = .84), but adolescents who delivered vaginally had a second stage that was one-third shorter than adults (62.5 vs 100.3 minutes; P < .001).
  
  
  CONCLUSIONS
  Adolescents are half as likely to undergo primary cesarean delivery overall, and 40% less likely to undergo a primary cesarean delivery in labor, even after adjustment for multiple maternal, neonatal, and labor characteristics. This difference is not explained by differences in the duration of the second stage of labor.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: jkatzeriksen@partners.org.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Katz Eriksen
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Alexander
authors.initials: A
authors.lastname: Melamed
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Clapp
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Little
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Chloe
authors.initials: C
authors.lastname: Zera
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008423:Maternal Age; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000209:etiology; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology; D011253:Pregnancy in Adolescence / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult
keywords: Adolescents; Cesarean section; Obstetric delivery; Pregnancy; Pregnancy in adolescence