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Objective The growing opioid crisis increasingly affects maternal care in the US and it is unknown if opioid use puts pregnant women at increased odds for cesarean delivery (CD). Understanding how opioids influence CD trends is important in improving maternal and neonatal outcomes. This study aims to understand the association of opioid use with CD in the context of the demographic, clinical, behavioral, and health system complexity. Methods This retrospective cross-sectional analysis used representative data from the 2012-2014 National Inpatient Sample. Opioid use during pregnancy, CD, and other clinical variables were identified using ICD9 codes. Characteristics were assessed using bivariate and multivariate statistics. A logistic regression model was used to determine the association between opioid use and CD while controlling for confounders. Adjustments were made for rural/urban hospital location, regional median income, maternal age, race, and medical and pregnancy-related conditions. Results The rate of CD in the overall sample was about 30%. Among opioids-users, the overall proportion of CD was significantly less (24.7%). The adjusted odds ratio for CD among opioids users was 0.74 (CI: 0.73-0.76, p < 0.001). This finding is unique to pregnant women who are covered by public insurance. In rural areas, the relationship between opioid use and CD was not significant. Conclusion Opioid use during pregnancy is associated with lower CD rates in urban settings. This evidence suggests that maternal care varies between rural and urban areas in relation to CD of pregnant opioid users compared to non-opioid users., Author(s): Carolyn Knoll [sup.1] , Beri Massa-Buck [sup.2] , Dinan Abdelatif [sup.2] , Amr Madkour [sup.3] , Mohamed Mohamed [sup.2] [sup.3] [sup.4] Author Affiliations: (1) grid.253615.6, 0000 0004 1936 9510, [...]

Objectives The aim of this prospective cohort study was to investigate the associations between maternal vitamin D status in late pregnancy and emergency caesarean section (EMCS) and birth asphyxia, in a population based sample of women in Sweden. Methods Pregnant women were recruited at the antenatal care in Sweden and 1832 women were included after exclusion of miscarriages, terminated pregnancies and missing data on vitamin D status. Mode of delivery was retrieved from medical records. EMCS was defined as caesarean section after onset of labour. Birth asphyxia was defined as either 5 min Apgar score < 7 or arterial umbilical cord pH < 7.1. Serum was sampled in the third trimester of pregnancy (T3) and 25-hydroxyvitamin D (25OHD) was analysed by liquid chromatography tandem mass spectrometry. Vitamin D deficiency was defined as 25OHD < 30 nmol/L, and associations were studied using logistic regression analysis and expressed as adjusted odds ratios (AOR). Results In total, 141 (7.7%) women had an EMCS and 58 (3.2%) children were born with birth asphyxia. Vitamin D deficiency was only associated with higher odds of EMCS in women without epidural anaesthesia (AOR = 2.01, p = 0.044). Vitamin D deficiency was also associated with higher odds of birth asphyxia (AOR = 2.22, p = 0.044). Conclusions for Practice In this Swedish prospective population-based cohort study, vitamin D deficiency in late pregnancy was associated with doubled odds of birth asphyxia and with EMCS in deliveries not aided by epidural anaesthesia. Prevention of vitamin D deficiency among pregnant women may reduce the incidence of EMCS and birth asphyxia. The mechanism behind the findings require further investigation., Author(s): Hanna Augustin [sup.1] , Sinead Mulcahy [sup.1] [sup.2] , Inez Schoenmakers [sup.3] [sup.4] , Maria Bullarbo [sup.5] [sup.6] , Anna Glantz [sup.7] , Anna Winkvist [sup.1] , Linnea Bärebring [...]

Objectives. We examined factors contributing to shifts in primary cesarean rates in the United States between 1991 and 2002. Methods. US national birth certificate data were used to assess changes in primary cesarean rates stratified according to maternal age, parity, and race/ethnicity. Trends in the occurrence of medical risk factors or complications of labor or delivery listed on birth certificates and the corresponding primary cesarean rates for such conditions were examined. Results. More than half (53%) of the recent increase in overall cesarean rates resulted from rising primary cesarean rates. There was a steady decrease in the primary cesarean rate from 1991 to 1996, followed by a rapid increase from 1996 to 2002. In 2002, more than one fourth of first-time mothers delivered their infants via cesarean. Changing primary cesarean rates were not related to general shifts in mothers' medical risk profiles. However, rates for virtually every condition listed on birth certificates shifted in the same pattern as with the overall rates. Conclusions. Our results showed that shifts in primary cesarean rates during the study period were not related to shifts in maternal risk profiles.

Objectives. The percentages of cesarean deliveries attributable to specific indications (breech, dystocia, fetal distress, and elective repeat cesarean) were computed for 1985 and 1994. Methods. Data were derived from the 1985 and 1994 National Hospital Discharge Surveys. Results. Dystocia was the leading indication for cesarean delivery in both years. In comparison with 1985, cesareans performed in 1994 that were attributable to dystocia and breech presentation increased, those attributable to fetal distress did not change significantly, and elective repeat cesareans declined. Conclusions. Studying indications for cesareans can be useful for hospitals, clinicians, and researchers in determining strategies to lower primary and repeat cesarean rates. (Am J Public Health. 1998;88:1384-1387)

The most common type of hospital surgery in the US is the cesarean section. There were 967,000 cesarean sections performed in the US in 1988, representing almost 25 percent of all births. The rate of cesarean section has quadrupled within the past 20 years, raising concerns about current obstetric practice. Thirty-six percent of cases were repeat cesarean sections, and only about 13 percent of women who underwent a previous cesarean section had a subsequent vaginal birth. Cesarean section contributes to increased health care costs and may often be clinically unnecessary. Higher rates of cesarean section have been associated with hospitals that operate for profit; patients with private insurance; increasing hospital size; higher socioeconomic status; and the presence of a neonatal intensive care unit. Thus, several clinical and nonclinical factors influence trends in medical practice. The influence of nonclinical factors. based on health care setting, on the use of repeat cesarean section was assessed in California hospitals. Among 45,425 births to women who had a previous cesarean section, only 11 percent were vaginal births. The rate of repeat cesarean section varied according to: hospital ownership (ranging from 4.9 percent for proprietary hospitals to 29.2 for the University of California hospital); hospital teaching level (ranging from 7.0 percent for non-teaching hospitals to 23.3 percent for teaching hospitals); payment source (ranging from 8.1 percent among women with private insurance to 25.2 percent among women receiving indigent services); and obstetric volume (with rates ranging from 5.4 percent in low-volume hospitals to 16.6 percent in high-volume hospitals). These findings suggest that nonclinical factors do affect decision-making and contribute to the variable rates of repeat cesarean section. (Consumer Summary produced by Reliance Medical Information, Inc.)