Trends in the distribution of gestational age and contribution of planned births in New South Wales, Australia.
Trends in the distribution of gestational age and contribution of planned births in New South Wales, Australia.
复制标题
DOI：
10.1371/journal.pone.0056238
复制
发表时间：
2013-01-01
期刊：
影响因子：
3.7
通讯作者：
Roberts, Christine L
中科院分区：
文献类型：
--
作者：
Nassar, Natasha;Schiff, Michal;Roberts, Christine L
背景：令人关切的是，计划生育率(通过产前剖腹产或引产)正在增加，而正在进行的妊娠正在减少。这项研究的目的是描述胎龄分布的趋势，并评估计划生育对任何此类变化的贡献。方法：我们利用新南威尔士州(NSW)围产期数据收集对澳大利亚新南威尔士州1994-2009年的所有出生人口进行了一项基于人口的研究。结果：从1994年到2009年，出生时胎龄的总体分布出现了逐渐而稳定的左移，模式孕周从40周下降到39周。对于独生子女来说，自然分娩的比例稳步但显著地下降。引产的比例增加了，引产的分布逐渐发生变化，从40周的多数转变为37-39周和41周的增加。产前剖宫产的比例也在每个胎龄稳步上升，并自1994年以来翻了一番，2009年大多数剖宫产发生在39周，而截至2001年为38周。结论：研究结果表明，早产的模式发生了变化，自然出生的婴儿减少了，计划出生的婴儿增加了。应评估与不断变化的临床实践相关的因素以及对母婴健康和福祉的长期影响。
BACKGROUND: There is concern that the rate of planned births (by pre-labour caesarean section or induction of labour) is increasing and that the gestation at which they are being conducted is decreasing. The aim of this study was to describe trends in the distribution of gestational age, and assess the contribution of planned birth to any such changes.METHODS: We utilised the New South Wales (NSW) Perinatal Data Collection to undertake a population-based study of all births in NSW, Australia 1994-2009. Trends in gestational age were determined by year, labour onset and plurality of birth.RESULTS: From 1994-2009, there was a gradual and steady left-shift in overall distribution of gestational age at birth, with a decline in the modal gestational age from 40 to 39 weeks. For singletons, there was a steady but significant reduction in the proportion of spontaneous births. Labour inductions increased in the proportion performed, with a gradual and changing shift in the distribution from a majority at 40 weeks to an increase at both 37-39 weeks and 41 weeks gestation. The proportion of pre-labour caesareans also increased steadily at each gestational age and doubled since 1994, with most performed at 39 weeks in 2009 compared with 38 weeks up to 2001.CONCLUSIONS: Findings suggest a changing pattern towards births at earlier gestations, fewer births commencing spontaneously and increasing planned births. Factors associated with changing clinical practice and long-term implications on the health and well-being of mothers and babies should be assessed.