Background

The rate of cesarean delivery has increased in the United States over the last several decades. However, the rate of cesarean delivery on maternal request remains undetermined, and recent data on cesarean delivery on maternal request are lacking.

Objective

This study aimed to describe the prevalence and temporal trends of cesarean delivery on maternal request in the United States and characterize the population of women who elect to undergo a cesarean delivery in the absence of fetal or maternal indications. Maternal outcomes between women who delivered by cesarean delivery on maternal request and those who did not were compared.

Study Design

A retrospective cohort study was conducted using data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 1999 to 2015. An algorithm based on International Classification of Diseases, Ninth Revision codes was created to identify patients who underwent a primary elective cesarean delivery in the absence of fetal or maternal indications. Maternal characteristics and outcomes between women who delivered by cesarean delivery on maternal request and those who did not were compared using descriptive and logistic regression analyses.

Results

Of the 13,698,835 deliveries included throughout the study period, 228,586 were identified as cesarean delivery on maternal request. Rates of cesarean delivery on maternal request among all live births increased throughout the study period, from 1% in 1999 to 1.62% in 2015 (P<.0001). Women who delivered by cesarean delivery on maternal request were more likely to be >35 years of age, were in the highest income quartile, and have private insurance. Cesarean delivery on maternal request was associated with an increased risk of venous thromboembolism (odds ratio, 1.9; 95% confidence interval, 1.8–2.0), myocardial infarction (odds ratio, 6.3; 95% confidence interval, 3.8–10.4), sepsis (odds ratio, 5.6; 95% confidence interval, 4.7–6.6), disseminated intravascular coagulation (odds ratio, 2.9; 95% confidence interval, 2.3–3.7), death (odds ratio, 14.5; 95% confidence interval, 11.4–18.6), and prolonged hospital stay (odds ratio, 4.9; 95% confidence interval, 4.8–5.1) and a lower risk of postpartum hemorrhage (odds ratio, 0.7; 95% confidence interval, 0.7–0.7).

Conclusion

Our findings indicated that cesarean delivery on maternal request accounts for a small but increasing proportion of all cesarean deliveries in the United States. Cesarean delivery on maternal request was more prevalent among women with certain demographic characteristics, indicating that the option of cesarean delivery on maternal request may be more appealing or more frequently offered to a certain population of women. Although the overall risk of adverse events is low for individual births, population effects can result in increased morbidity and mortality. Therefore, the rates of cesarean delivery on maternal request should be monitored on a national level. Study findings were limited by the absence of a specific diagnostic code for cesarean delivery on maternal request.

中文翻译：

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1999 年至 2015 年美国应产妇要求剖宫产

背景

在过去的几十年里，美国的剖宫产率有所增加。然而，应产妇要求剖宫产的比率仍未确定，并且缺乏有关产妇要求剖宫产的最新数据。

客观的

本研究旨在描述美国应产妇要求进行剖宫产的流行率和时间趋势，并描述在没有胎儿或产妇指征的情况下选择进行剖宫产的女性人群。比较了应产妇要求通过剖宫产分娩的妇女与未进行剖宫产的妇女的产妇结局。

学习规划

使用来自 1999 年至 2015 年医疗保健成本和利用项目-全国住院患者样本的数据进行了一项回顾性队列研究。创建了基于国际疾病分类第九修订版代码的算法，以识别在美国接受初次择期剖宫产的患者。没有胎儿或母体适应症。使用描述性和逻辑回归分析比较了应产妇要求通过剖宫产分娩的女性与未分娩的女性之间的产妇特征和结局。

结果

在整个研究期间纳入的 13,698,835 例分娩中，有 228,586 例被确定为应产妇要求进行剖宫产。在整个研究期间，所有活产婴儿的剖宫产率均有所上升，从 1999 年的 1% 上升到 2015 年的 1.62%（P<.0001)。应产妇要求通过剖宫产分娩的女性更有可能年龄 > 35 岁，处于最高收入四分位数，并拥有私人保险。应产妇要求进行剖宫产与静脉血栓栓塞（优势比，1.9；95% 置信区间，1.8-2.0）、心肌梗塞（优势比，6.3；95% 置信区间，3.8-10.4）、败血症（优势比，1.9）风险增加相关。优势比，5.6；95% 置信区间，4.7–6.6），弥散性血管内凝血（优势比，2.9；95% 置信区间，2.3–3.7），死亡（优势比，14.5；95% 置信区间，11.4–18.6）和延长住院时间（优势比，4.9；95% 置信区间，4.8–5.1）和较低的产后出血风险（优势比，0.7；95% 置信区间，0.7–0.7）。

结论

我们的研究结果表明，在美国所有剖宫产中，应产妇要求进行剖宫产的比例很小，但比例不断上升。应产妇要求剖宫产在具有某些人口特征的女性中更为普遍，这表明应产妇要求剖宫产的选择可能对某些女性群体更具吸引力或更频繁。尽管个体出生不良事件的总体风险较低，但人口效应可能导致发病率和死亡率增加。因此，应在全国范围内监测应产妇要求的剖宫产率。由于缺乏应产妇要求进行剖宫产的特定诊断代码，研究结果受到限制。