(55) Incidence, Indications, and Complications of Cesarean Delivery Among Adolescent Childbirths: National Inpatient Sample 2019-2021

Background: Cesarean deliveries in the United States have increased over the recent decades. The impact of this increase on the adolescent population has not been precisely defined.

Methods: We performed a 3-year cross-sectional analysis of cesarean deliveries in individuals aged 10 to 19 years captured in the National Inpatient Sample from 2019 to 2021.

Results: Cesarean deliveries in individuals aged 10-19 represented 2.67 % of all cases. Geographically, over half of adolescent births occurred in rural areas (57.3 %), followed by urban areas (25.7 %), and least frequently in suburban regions (16.9 %). 38.9% of the individuals in the sample were identified as White, 29% as Hispanic, and 26.1 % as Black. Multifetal gestations accounted for 2.9 %. Among the most common diagnoses associated with cesarean, non-reassuring fetal status was documented in 41.4 % of cases, labor dystocia in 27 %, and repeat operation in 11.3 %. Notably, the incidence of failed TOLAC was 21.6 %. Incidence of commonly noted delivery complications was 10.7 % for meconium in amniotic fluid, 6 % for chorioamnionitis, 3.2 % for placental abruption, 2.9 % for multifetal gestation, and 2 % for malpresentation. Common maternal complications included anemia at 23 %, obesity at 15.4 %, mental health disorders at 11.1 %, gestational hypertension at 8.8 %, postpartum hemorrhage at 4.4 %, and blood transfusion at 3.5 %. Among severe complications, cases of placenta accreta spectrum, hysterectomy, and bowel or bladder injury were noted, though the incidence was very small (less than 0.1 % for all).

Conclusions: Cesarean delivery in adolescents is common, with indications similar to those previously reported in adult populations. Complications, including severe complications like placenta accreta disorders, organ injuries, and hysterectomy, did occur in this age group. Given the risk of complications and potential for future morbidity from repeat cesareans, monitoring rates of cesarean delivery in this age group and efforts for safe prevention of primary cesarean are warranted. These findings reaffirm the need to provide comprehensive obstetric and neonatal care to address complex health issues surrounding childbearing in this age group.