Factors Associated with Cesarean Delivery in Myelomeningocele Pregnancies [35E]

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Abstract

INTRODUCTION:

Myelomeningocele (MMC) complicates 1 in 2000 pregnancies in the United States. Mode of delivery for myelomeningocele (MMC) is controversial but there is limited data to support the benefit of cesarean delivery (CD). We sought to determine the rate of CD and characteristics associated with CD in MMC pregnancies.

METHODS:

Population-based retrospective cohort study of livebirths in Ohio (2006-2015). Frequency of CD, obtained from birth certificate data, was reported for women with a singleton, isolated MMC pregnancy. Obstetric characteristics were compared between women who underwent CD compared to vaginal delivery (VD).

RESULTS:

Of 1,409,231 live births in Ohio during the 10-year study period, 355 (0.02%) women had a singleton infant with MMC. Of these pregnancies, 70.7% (n=251/355) underwent a CD. While the rate of CD increased from 64.7 to 76.1% (p=0.02) in births after 2010 (2011-2015) compared to before (2006-2010), the rate of induction decreased (15.7 vs 8.5%, p=0.04). The CD rate for women delivering at an academic center was 83.8 vs 62.6% (p<0.001) compared to those who delivered at a community hospital. Factors associated with CD included delivery at an academic center (aOR 4.2, 95%CI 2.3-7.8) and delivery in the latter-half of the study period (aOR, 2.0, 95%CI 1.2-3.5).

CONCLUSION:

Approximately 7 in 10 women with MMC pregnancy delivered by cesarean. Delivery at an academic center was associated with a 4-fold increase in CD. Additionally, there was a temporal rise in CD rates across the 10-yr period correlating with decreased IOL suggesting a rise in planned CD by providers, particularly at academic centers.

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