Regional Variation in the Cesarean Delivery and Assisted Vaginal Delivery Rates
Regional Variation in the Cesarean Delivery and Assisted Vaginal Delivery Rates
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DOI：
10.1097/aog.0b013e3181dd918c
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发表时间：
2010-06-01
影响因子：
7.2
通讯作者：
Greyson, Devon
中科院分区：
文献类型：
--
作者：
Hanley, Gillian E.;Janssen, Patricia A.;Greyson, Devon
目的：研究不列颠哥伦比亚省人口中初次剖宫产率和辅助阴道分娩比率的地区差异，同时调整增加手术分娩可能性的产妇特征和条件。方法：利用不列颠哥伦比亚省围产期数据库登记处的数据，我们研究了不列颠哥伦比亚省2004至2007年间的所有分娩，排除了既往剖腹产的妇女(n=116,839)。我们感兴趣的主要结果是分娩方式，进一步定义为剖腹产或辅助阴道分娩。我们计算了不列颠哥伦比亚省16个卫生服务区的初级剖宫产率和风险调整后的剖宫产率，并根据手术指征检查了剖宫产率。结果：初级剖宫产率和辅助阴道助产率在卫生服务区的差异很大，分别为每100次分娩16.1至27.5次和8.6至18.6次。剖宫产最常见的指征是难产，占所有剖腹产的30.0%，在不同地区的差异超过五倍。在控制了已知的增加剖腹产和辅助阴道分娩可能性的产妇特征和条件后，调整后的剖宫产率变化了两倍，从每100次分娩14.7到27.6次不等，而调整后的辅助阴道分娩率变化了两倍多，从每100次分娩的6.5次到15.3次。结论：我们的结果说明了剖腹产使用的显著地区差异，这不能用患者的疾病或偏好来解释。这种差异可能反映了从业者在医疗决策方面的不同方法。(Obstet Gyneol 2010；115：1201-8)
OBJECTIVE: To examine regional variations in rates of primary cesarean delivery and assisted vaginal delivery in the population of British Columbia, while adjusting for the maternal characteristics and conditions that increase the likelihood of operative delivery.METHODS: Using data from the British Columbia Perinatal Database Registry, we studied all deliveries in British Columbia between 2004 and 2007, excluding women who had a previous cesarean delivery (n=116,839). Our primary outcome of interest was mode of delivery, further defined as delivery by cesarean or assisted vaginal delivery. We calculated crude and risk-adjusted rates of primary cesarean delivery and assisted vaginal delivery across British Columbia's 16 Health Service Delivery Areas and examined cesarean delivery rates by indication for the procedure.RESULTS: Crude primary cesarean delivery and assisted vaginal delivery rates varied markedly across the Health Service Delivery Areas ranging from 16.1 to 27.5 per 100 deliveries, and from 8.6 to 18.6 per 100 deliveries, respectively. The most common indication for cesarean delivery was dystocia, which accounted for 30.0% of all cesarean deliveries and varied more than fivefold across regions. After controlling for maternal characteristics and conditions known to increase the likelihood of cesarean delivery and assisted vaginal delivery, adjusted cesarean delivery rates varied twofold, ranging from 14.7 to 27.6 per 100 deliveries, while adjusted assisted vaginal delivery rates varied by more than twofold, ranging from 6.5 to 15.3 per 100 deliveries.CONCLUSION: Our results illustrate substantial regional variation in the use of cesarean delivery that cannot be explained by patient illness or preferences. This variation likely reflects differences in practitioners' approaches to medical decision-making. (Obstet Gynecol 2010; 115: 1201-8)