(814) Impact of quality improvement efforts at a population level: evidence from cesarean birth trends

Objective: In response to rising cesarean birth rates, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine published guidance for prevention of the primary cesarean in 2014. Our objective was to evaluate trends in cesarean birth rates in the United States from 2012-2020.

Study Design: Retrospective observational study of delivery data from National Vital Statistics System. Inclusion criteria were singleton, non-anomalous, term (37w0d-42w0d) gestation, vertex deliveries. We examined trends in rates of cesarean birth from 2012-2020 in nulliparas, multiparas without prior cesarean, and multiparas with prior cesarean utilizing Cochrane-Armitage test of trend. Risk ratios (95% Confidence interval) comparing cesarean rates for 2020 with 2012 were estimated.

Results: In total, 27,221,575 cesarean births were included. Overall, the rate of cesarean birth decreased from 27.8% (95% confidence interval 27.7%, 27.9%) in 2012 to 26.9% (95% confidence interval 26.9%, 27.0%) in 2020 with a risk ratio (RR) of 0.97 (95% confidence interval 0.97, 0.98). Cesareans were decreased in nulliparous (26.9% (26.9%, 27.1%) in 2012 to 25.9% (25.8%, 25.9%) in 2020 with a RR of 0.96 (0.95, 0.96)), multiparous with prior cesarean (88.9% (88.8%, 89.1%) in 2012 to 85.1% (84.9%, 85.2%); RR (0.97 (0.97, 0.97)) and multiparous without prior cesarean (10.3% (10.2%, 10.3%) in 2012 to 9.16% (9.12%, 9.21%) in 2012; RR=0.97 (0.97, 0.97). Cesarean birth rates declined across subgroups stratified by parity: in nulliparas as well as multiparas both with and without prior cesarean (p< 0.001, Cochran Armitage test of trend) (Figure 1).

Conclusion: Quality improvement bundles aimed at safe prevention of primary cesarean birth may be associated with a reduction in overall cesarean birth including in multiparas with and without prior cesarean birth.