Cervical dilation at time of caesarean delivery in nulliparous women: a population-based cohort study.

OBJECTIVES

Our objective was to describe contemporary practice patterns in the timing of caesarean delivery in relation to cervical dilation, overall and by indication for caesarean. Our secondary objective was to examine how commonly caesarean delivery was performed for labour dystocia at dilations below 4 cm or without the use of oxytocin, overall and between hospitals.

DESIGN

Retrospective, population-based cohort study.

SETTING

Ontario, Alberta, and British Columbia, Canada, 2008-2012.

POPULATION

Nulliparous women in labour who delivered term singletons in cephalic position.

METHODS

Histograms were used to examine the distribution of cervical dilation at time of caesarean delivery, overall and by indication for caesarean. Funnel plots were used to illustrate variation in hospital-level rates of caesarean deliveries for labour dystocia that were performed early (<4 cm dilation) or without the use of oxytocin.

MAIN OUTCOME MEASURES

Cervical dilation (in centimetres) at time of caesarean delivery.

RESULTS

The population-based cohort comprised 392 025 women, of whom 18.8% had a caesarean delivery. Of first-stage caesareans for labour dystocia in women who entered labour spontaneously, 13.6% (95% CI 12.9, 14.2) had dilations <4 cm [hospital-level inter-quartile range (IQR): 6.2% to 20.0%] and 29.5% (95% CI 28.6, 30.4) did not receive oxytocin to treat their dystocia (hospital-level IQR: 22.1-54.6%).

CONCLUSIONS

The proportion of caesareans done before 4 cm dilation or without oxytocin varies substantially across hospitals and suggests the need for institutions to review their practices and ensure that management of labour practice guidelines are followed.

TWEETABLE ABSTRACT

Many caesareans for labour dystocia are performed early during labour (<4 cm dilation) or without oxytocin.