Temporal trends in operative obstetric delivery: 1992–1999

Objective: To evaluate the rates of operative obstetric delivery by indication and gestational age longitudinally from 1992 to 1999. Methods: We reviewed our obstetric database from August 1992 to July 1999, identifying all women undergoing operative obstetric delivery. Incidence, gestational age, and indication for each delivery were recorded and compared temporally over the study interval. Statistical analyses were performed using the χ2 test. Results: Over the study interval, 12,491 deliveries were recorded: 72.0% spontaneous vaginal delivery, 6.8% low/outlet forcep delivery, 0.3% mid-forcep delivery, 2.1% vacuum delivery, and 17.9% cesarean delivery. A significant reduction in the use of forceps was noted from 1992 (10.4%) to 1999 (5.6%) (P<0.0001), as well as a decreased rate of vacuum delivery (2.2% versus 1.3%, respectively) (P <0.05). The rate of cesarean delivery gradually and significantly increased from 14.6% in 1992 to 21.4% in 1999 (P <0.0001). When analyzed by cesarean delivery indication, no significant changes were noted in the rates of cesarean section for labor arrest, presumed fetal distress, malpresentation, multifetal gestation, or elective repeat cesarean delivery. Conclusion: The temporal trend of increased cesarean delivery rate appears to be secondary to reduced rate of forceps and vacuum assisted delivery.