It is unknown whether primary cesarean deliveries (CDs) performed in compliance with the 2014 ACOG/SMFM Obstetric Care Consensus Statement (“guideline-compliant”) are associated with a modified risk of maternal and neonatal morbidity, when compared to primary CDs performed outside the new guidelines (“guideline-noncompliant”). Our primary objective was to determine if a guideline-compliant primary CD is associated with a modified risk for maternal or neonatal morbidity, when compared to guideline-noncompliant primary CD.METHODS:
Retrospective cohort study of women undergoing primary CD at the state’s largest maternity hospital in 2015. Maternal, neonatal, and labor course variables were collected via review of electronic clinic records and labor notes. Univariate and logistic regression analyses were performed, where appropriate.RESULTS:
827 women delivered via primary CDs during the study period, of which 288 (34.8%) were guideline-compliant, 215 (26.0%) guideline-noncompliant, and 324 (39.2%) guideline-not addressed. Women undergoing guideline-compliant primary CD were no more likely to experience an adverse maternal outcome compared to guideline-noncompliant and guideline-not addressed primary CDs, in adjusted analysis (AOR 1.10, 95% CI .58-2.07; AOR 1.20, 95% CI .67-2.14 respectively). However, guideline not-addressed primary CDs were associated with a significantly increased risk of any adverse maternal or neonatal outcomes, when compared to guideline-compliant primary CDs (AOR 4.16, 95% CI 2.78-6.23).CONCLUSION:
Guideline-compliant primary CDs were not associated with increased risk of maternal or neonatal morbidity when compared to guideline-noncompliant primary CDs. Compliance with the 2014 Obstetric Care Consensus Statement may be associated with a decreased primary CD rate without an increased risk of adverse outcomes.