Stabilising the caesarean rate: which target population?
Stabilising the caesarean rate: which target population?
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DOI：
10.1111/1471-0528.13199
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发表时间：
2015-04-01
影响因子：
5.8
通讯作者：
Goffinet, F.
中科院分区：
文献类型：
--
作者：
Le Ray, C.;Blondel, B.;Goffinet, F.
法国的剖腹产率在1995年至2003年期间有所上升，但在2003年至2010年期间保持稳定。我们的目标是通过确定妇女群体谁的增加和谁的稳定作出了贡献，以分析这些趋势。设计横断面人口为基础的研究，从法国全国围产期调查。设置所有产科单位在法国。人口代表性样本的妇女交付在1995年（n=13147），2003年（n=14482），方法采用Robson分类法，根据妊娠和分娩特点，对各组进行分类，主要观察指标：各组的剖宫产率，其对总剖宫产率的贡献，结果1995年剖宫产率为15.4%，2003年19.7%，2010年20.5%。1995年至2003年期间，除一个群体外，所有群体的剖腹产率都有所上升。在2003年至2010年期间，除三个组外，所有组的贡献都稳定或下降：足月单胎头位胎儿的自然分娩的未经产妇女（=+0.5%，95%CI 0.1-0.9%），增加的原因是剖腹产率较高;足月引产的未产妇（=+1.1%，95%CI 0.8-1.4%），这是由于该组的剖腹产率和相对大小增加所致;和妇女以前剖腹产（=+0.8%，95%CI 0.3-1.3%），因为这个群体的规模不断扩大。ConclusionProposing and Evaluating Interventions for Improving the Management of Labour in nulliparous Women could Help to Maintain剖腹产率，并减轻未来多产妇女的增加。
ObjectiveCaesarean rate increased in France between 1995 and 2003, but remained stable between 2003 and 2010. Our objective was to analyse these trends by identifying the groups of women who contributed to the increase and those who contributed to the stabilisation.DesignCross-sectional population-based study from the French national perinatal surveys.SettingAll maternity units in France.PopulationRepresentative samples of women delivering in 1995 (n=13147), 2003 (n=14482), and 2010 (n=14681).MethodsRobson classification, based on pregnancy and delivery characteristics, was used for each group.Main outcome measuresCaesarean rate for each group, its contribution to the overall caesarean rate, and the differences () in these contributions between 1995 and 2003 and between 2003 and 2010.ResultsOverall caesarean rates were 15.4% in 1995, 19.7% in 2003 and 20.5% in 2010. Between 1995 and 2003, the contribution to the overall caesarean rate of all groups but one rose. Between 2003 and 2010, the contribution of all groups but three stabilised or decreased: nulliparous women in spontaneous labour with singleton cephalic fetuses at term (=+0.5%, 95% CI 0.1-0.9%), an increase explained by their higher caesarean rate; nulliparous women with induced labour at term (=+1.1%, 95% CI 0.8-1.4%) caused by an increase in both the caesarean rate and the relative size of this group; and women with previous caesarean (=+0.8%, 95% CI 0.3-1.3%), because of the growing size of this group.ConclusionProposing and evaluating interventions for improving the management of labour in nulliparous women could help to maintain caesarean rates and mitigate increases among multiparous women in the future.