From the Guidelines
The most common reason for a primary cesarean section in the United States is dystocia, accounting for approximately 37% of all primary C-sections. This is based on the indications for cesarean delivery summarized by the Maternal-Fetal Medicine Unit Network, as reported in a study published in the American Journal of Obstetrics and Gynecology 1.
Key Points to Consider
- Dystocia is a condition where labor does not advance as expected, with inadequate cervical dilation, fetal descent, or both, despite adequate contractions.
- The other primary indications for cesarean delivery include nonreassuring fetal heart rate (25%), abnormal fetal presentation (20%), and other indications (15%) 1.
- It is essential to understand the common indications for primary C-sections to develop effective strategies for reducing morbidity and mortality rates associated with cesarean delivery.
Clinical Implications
- Healthcare providers should be aware of the common indications for primary C-sections and take a multidisciplinary approach to manage labor and reduce the need for surgical intervention.
- Efforts to reduce primary C-section rates should focus on allowing more time for labor to progress naturally before intervening surgically, while also ensuring the safety of both the mother and the baby.
- The diagnosis of dystocia should be made after excluding other causes of slow labor progression, such as fetal malpositioning or cephalopelvic disproportion 1.
From the Research
Primary Cesarean Section in the United States
The most common reasons for a primary cesarean section in the United States are:
- Labor dystocia
- Abnormal or indeterminate fetal heart rate tracing
- Fetal malpresentation
- Multiple gestation
- Suspected fetal macrosomia 2 Other studies also indicate that failure to progress, nonreassuring fetal heart rate tracing, and fetal malpresentation are common indications for primary cesarean delivery 3.
Indications for Primary Cesarean Delivery
The frequencies of these indications can vary by parity, with failure to progress being the most common indication for primiparous women and nonreassuring fetal heart rate tracing being a common indication for both primiparous and multiparous women 3. Historically, dystocia, fetal distress, and breech presentations were also common indications for primary cesarean section 4.
Strategies to Reduce Primary Cesarean Delivery Rate
Strategies to reduce the primary cesarean delivery rate may include revisiting the definition of labor dystocia, improving and standardizing fetal heart rate interpretation and management, and increasing women's access to nonmedical interventions during labor, such as continuous labor and delivery support 2. Additionally, aligning provider incentives for vaginal birth, limiting elective induction of labor, and improving labor management of dystocia and abnormal fetal heart rate tracings may also be effective 5.