Lowered national cesarean section rates after a concerted action
Lowered national cesarean section rates after a concerted action
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DOI：
10.1111/aogs.12582
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发表时间：
2015-04-01
影响因子：
4.3
通讯作者：
Vicente, Lisa
中科院分区：
文献类型：
--
作者：
Ayres-De-Campos, Diogo;Cruz, Joana;Vicente, Lisa
目的评估葡萄牙自2010年起采取一致行动降低剖宫产率后的全国剖宫产率和其他产科指标。这一行动是基于信息的传输和医疗保健专业人员的培训，连同纳入CS率作为医院funding. DesignRetrospective-observational population-based study.SettingPortugal.PopulationBirths发生在葡萄牙之间2000年和2014.MethodsGovernmental来源获得的数据对国家CS，围产期和孕产妇死亡率。检索国有医院的阴道助产率、剖宫产后阴道分娩率、缺氧相关并发症和会阴裂伤率。主要结局指标CS、围产儿和孕产妇死亡率、阴道助产率、剖宫产后阴道分娩率、缺氧相关并发症和会阴裂伤率。在随后的5年中，全国CS率显著下降（36.6% vs. 33.1%，时间趋势p <0.001）。在此期间，围产期死亡率保持下降趋势，而孕产妇死亡率保持不变。率的仪器阴道分娩，VBAC和会阴裂伤增加，而缺氧相关的并发症的发病率decreased.ConclusionsA协调一致的行动的基础上传输的信息和培训的医疗保健专业人员，连同列入CS率作为一个标准的医院资金，其次是一个显着减少国家CS率，以及改善最相关的产科指标。报告的干预措施与观察到的变化之间可能存在关联。
ObjectiveTo evaluate national cesarean section (CS) rates and other obstetric indicators after a concerted action to reduce CS rates was undertaken in Portugal from 2010 onwards. This action was based on the transmission of information and training of healthcare professionals, together with the inclusion of CS rates as a criterion for hospital funding.DesignRetrospective observational population-based study.SettingPortugal.PopulationBirths occurring in Portugal between 2000 and 2014.MethodsGovernmental sources were used to obtain data on national CS, perinatal and maternal mortality rates. Rates of instrumental vaginal delivery, vaginal birth after cesarean (VBAC), hypoxia-related complications and perineal lacerations were retrieved for state-owned hospitals.Main outcome measuresCS, perinatal and maternal mortality, instrumental vaginal delivery, VBAC, hypoxia-related complications and perineal lacerations.ResultsAfter a continuous rise between 2000 and 2009, national CS rates declined significantly over the following 5years (36.6% vs. 33.1%, time trend p0.001). Perinatal mortality maintained a downward trend during this period, while maternal mortality remained unchanged. Rates of instrumental vaginal delivery, VBAC and perineal lacerations increased, while the incidence of hypoxia-related complications decreased.ConclusionsA concerted action based on the transmission of information and training of healthcare professionals, together with the inclusion of CS rates as a criterion for hospital funding, was followed by a significant reduction in national CS rates, as well as an improvement in most related obstetric indicators. There may be an association between the reported intervention and the observed changes.