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Poster Session 4

(1130) Cesarean Delivery on Maternal Request Among Nulliparous Women: Rates, Timing and 10-Year Trends

Friday, January 31, 2025
4:00 PM – 6:00 PM  

    Submitting Author and Presenting Author(s)

  • NM

    Niall McGowan

    Medical Student
    University of Galway
    Galway, Galway, Ireland

    • Coauthor(s)

  • CG

    Clare Greaney, RN

    Clinical Midwife Manager
    Galway University Hospital - Ireland
    Galway University Hospital - Ireland, Galway, Ireland

  • JM

    John J. Morrison, BSc, FRCOG, MBBCH, MD

    Professor/Head of Department/Consultant Obstetrician
    Dept. of Obstetrics and Gynecology University of Galway - Ireland
    University of Galway - Ireland, Galway, Ireland

Objective:

Cesarean delivery on maternal request (CDMR) is defined as caesarean delivery (CD) performed without a clinical reason, i.e. no fetal or maternal indication. It is a controversial area of practice with huge variation in general CDMR rates globally (1,2). However it is difficult to ascertain nulliparous rates resulting in the primary CD. The aims of this study were to determine the following: 1. CDMR rate for nullipara in Irish obstetric practice; 2. Contribution of CMDR to overall CD rates; 3. Associated demographic features and models of obstetric care; 4. Trends in CDMR rates throughout 2014-2023.

Study Design:

The data were obtained from EuroKing Obstetric Database at Galway University Hospital, a tertiary referral center in the West of Ireland. The information had been entered prospectively during 2014-2023. Descriptive statistics were calculated for each year, and compared using Chi2 for proportions and trend, using the program GraphPad Prism v10.2.3. Ethical Committee approval for the study was obtained. 

Results:

There were 28,264 deliveries of which 10,259(36.3%) were nullipara with singleton pregnancies ³ 36 weeks. There were n= 134 CDs performed solely for maternal request which represented 1.3% of all nullipara. CDMR contributed to 3.8% of all nulliparous CDs, and constituted 1.4% of all hospital CDs. The maternal age, BMI, and birthweight characteristics of these pregnancies are shown in Table 1. The prevalence of CDMR among nullipara attending a private obstetrician for care was 5.9% and was 0.7% (P < 0.0001) for women attending for public hospital care. The CDMR rate among nullipara increased significantly over the duration of the study from 0.9% in 2014 to 2.7% in 2023 (P < 0.0001), Figure 1.

Conclusion:

These findings describe the prevalence of CDMR among nulliparous women and the subsequent contribution to overall CD rates. A significant increase in rates was observed in the last decade. The rates of CDMR were higher among women attending a private obstetric service.

References

1. Jenabi E et al. J Mat-Fetal & Neo Med 2020; 33: No.22, 3867-3872

2. Begum T et al. BJOG 2020; 128:798-806