The Effect of Race on Interventional Thresholds in Patients Undergoing Cesarean Deliveries [ID 1384]

INTRODUCTION: Black women have the highest rates of maternal morbidity, mortality, and cesarean delivery (CD) in the United States. We aimed to examine the effect of race on labor and peripartum morbidities in patients undergoing CD. METHODS: We conducted a retrospective, observational study using data extracted from electronic medical records of primiparous individuals at term gestation who underwent singleton CD, at a large academic medical institution and eight affiliated hospitals July 2017 to June 2019 and July 2021 to June 2023. Data was analyzed using chi-squared, Fisher’s exact, or Mann–Whitney U tests. RESULTS: Among the 3,799 CDs, 9% self-identified as Black and 91% as White. Black patients were more likely to be younger (27 versus 30 years), have public insurance (55% versus 21%), hypertension (12% versus 6%), an unplanned CD (83% versus 74%), labor induction/augmentation (72% versus 65%), and CD for non-reassuring fetal heart tones (53% versus 31%), compared to White patients ( P <.05 for all). In patients who labored, first stage of labor and time from labor to delivery were 66% (median 1,065 versus 642 minutes, P =.03) and 38% (median 1,351 versus 932 minutes, P < 0.01) longer for Black versus White patients, respectively. Black patients had higher rates of chorioamnionitis (13% versus 8%, P <.01) and longer hospital stays (4 versus 3 days, P <.01). No differences were observed in rates of diabetes, asthma, second stage of labor duration, preeclampsia, postpartum hemorrhage, deep vein thrombosis, or genitourinary/gastrointestinal injuries. CONCLUSIONS/IMPLICATIONS: Racial disparities exist in patients who labor and undergo CD. Understanding factors driving these discrepancies may help with developing clinical guidelines that can improve Black maternal health.