A retrospective review of clinical and non-clinical factors associated with unscheduled cesarean deliveries at one urban medical center

Abstract

Objective: To investigate factors associated with unscheduled cesarean delivery at one urban tertiary medical center. Methods: A retrospective chart review was performed on 11 162 deliveries between 2009 and 2019. The dependent variable was unscheduled cesarean delivery. Covariates examined included time of delivery, as well as several maternal and pregnancy-related factors. Results: There were a total of 7037 (63.1%) vaginal, 1133 (10.1%) elective cesarean, and 2992 (26.8%) unscheduled cesarean deliveries. Independent factors associated with increased odds for unscheduled cesarean delivery included daytime delivery (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.18–1.42, P < 0.001); advanced maternal age (OR 1.40, 95% CI 1.26–1.56, P < 0.001); obesity (OR 1.04, 95% CI 1.03–1.05, P < 0.001); history of previous cesarean delivery (OR 2.77, 95% CI 1.91–4.01, P < 0.001); hypertension (OR 1.72, 95% CI 1.27–2.32, P < 0.001); multiparity (OR 3.99, 95% CI 2.82–5.64, P < 0.001); pre-eclampsia (OR 1.96, 95% CI 1.33–2.89, P = 0.001); and HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome (OR 5.45, 95% CI 1.13–26.28, P = 0.035). Conclusion: Factors associated with unscheduled cesarean delivery in this study cohort included daytime delivery, advanced maternal age, obesity, hypertension, previous cesarean delivery, multiparity, preterm labor, pre-eclampsia, and HELLP syndrome.