Eichelberger K, et al. - The researchers aimed at comparing contemporary primary cesarean delivery (CD) rates and indications for primary CD by race/ethnicity at South Carolina’s largest regional perinatal center. They also compared the rates of maternal and neonatal complications associated with primary CD by race/ethnicity. As per observations, a significant variation in risk of morbidity existed from primary cesarean delivery. The non-Hispanic Black women exhibited a disproportionate burden.

Methods

• Researchers performed a retrospective cohort study of all women undergoing primary CD.
• A comprehensive manual review of individual prenatal records, labor notes, operative reports, discharge summaries, and postpartum records was performed for data extraction to determine the indication for and morbidity from cesarean.
• They included Chi square, Fisher’s exact test, t-tests and logistic regression for statistical analysis.

Results

• Via primary CD, 827 women delivered.
• Of these, 66.1%, 20.1%, 10.2% and 3.6% were non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic, and Other, respectively.
• Observations revealed no significant difference in primary CD rate when stratified by race/ethnicity (17.17% NHW, 18.78% NHB, 12.16% Hispanic, and 16.85% Other; p=0.15).
• Researchers noticed that relative to NHW women, NHB women were delivered significantly more often for non-reassuring fetal heart rate (23% vs 39%, p < 0.001), but significantly less frequently for arrest of the second stage (12% vs 4%, p=0.009).
• NHB women showed 2.5 times higher risk of receiving a blood transfusion and 4 times higher risk of readmission to the ICU when compared to NHW women (p=0.013 and 0.010, respectively).
• Logistic regression analysis suggested that NHB and Hispanic women, compared to NHW women, were more likely to experience at least 1 adverse maternal outcome (AOR 1.56, 95% CI 1.01, 2.41, and AOR 1.98, 95% CI 1.14, 3.29).
• Across the four race/ethnicity groups, adverse neonatal outcomes were statistically similar with the exception of umbilical cord pH< 7, which was 6 times more common in NHB women when compared to NHW women (0.01% vs 0.06%, p=0.006).