Elective C-Section Rates Vary by Hospital Type.

KAMUELA, HAWAII -- Corporate hospitals had the highest elective primary cesarean delivery rates, and Kaiser hospitals had the lowest in a study of hospital discharge records in California during 1995.

Malpresentation was by far the most common indication for an elective primary cesarean delivery (EPCD) followed by antepartum bleeding, herpes, macrosomia, and severe hypertension or preeclampsia, Dr. Kimberly D. Gregory said at the annual meeting of the Pacific Coast Obstetrical and Gynecological Society.

Other reasons for an EPCD included multiple gestation, uterine scarring, an unengaged head, soft tissue disorders such as fibroid uterus, preterm delivery, other hypertension, and fetal anomaly. In only 7% of cases was there an unspecified reason tar an EPCD, said Dr. Gregory, director of women's health policy and a maternal/fetal medicine specialist at Cedars-Sinai Medical Center in Los Angeles.

She examined 463,196 hospital discharge records describing deliveries, including 19,664 EPCDs, to determine whether there were any correlations between the type of delivery and clinical conditions, hospital type, maternal demographics, and insurance types. She found that 4.2% of all deliveries were EPCDs, but the rate varied tremendously--from a low of 0.5% to a high of 11.9%--when she teased out various patient and hospital factors.

The average age of women who had an EPCD was 28.6 years, while the average age of all women who gave birth in California in 1995 was 26.8 years. Hispanic women had the lowest EPCD rate, 3.7%, compared with 4.2% for black women and 5% for non-Hispanic white women.

Corporate hospitals had an EPCD rate of 4.5%; private hospitals, 4.2%; church-owned hospitals, 3.8%; and Kaiser hospitals, 3.3%.

Using the complex ...