Primary cesarean delivery in the United States.
Primary cesarean delivery in the United States.
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DOI：
10.1097/aog.0b013e3182952242
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发表时间：
2013-07
影响因子：
7.2
通讯作者：
Laughon SK
中科院分区：
文献类型：
--
作者：
Boyle A;Reddy UM;Landy HJ;Huang CC;Driggers RW;Laughon SK
旨在描述大型全国队列中初次剖宫产的适应症，并确定降低美国初次剖宫产率的机会。对 2002 年至 2008 年参加安全劳动联盟的地点的 228,562 例分娩中的 38,484 例初次剖腹产进行的回顾性队列研究。初产妇的初次剖腹产率为 30.8%，经产妇为 11.5%。初次剖宫产最常见的指征是进展失败（35.4%）、胎心率追踪不可靠（27.3%）和胎先露异常（18.5%），尽管每种指征的频率因胎次而异。在未能进展的女性中，42.6% 的初产女性和 33.5% 的经产女性在分娩前从未进展超过 5 厘米。在达到第二产程的产妇中，17.3%的人在2小时前因胎停产而接受剖宫产，只有1.1%的人尝试阴道手术分娩。在所有初次剖腹产中，45.6% 是对头位单胎的足月初产妇进行的。以6厘米作为主动临产的界限，为第二产程留出足够的时间，并在适当的时候鼓励手术阴道分娩，可能是降低初次剖宫产率的重要策略。这些措施对于头位单胎的足月初产妇可能特别重要。
To characterize the indications for primary cesarean delivery in a large national cohort and to identify opportunities to lower the U.S. primary cesarean rate. A retrospective cohort study of the 38,484 primary cesarean deliveries among the 228,562 deliveries at sites participating in the Consortium on Safe Labor from 2002 to 2008. The primary cesarean rate was 30.8% for primiparous women and 11.5% for multiparous women. The most common indications for primary cesarean delivery were failure to progress (35.4%), nonreassuring fetal heart rate tracing (27.3%), and fetal malpresentation (18.5%), although frequencies for each indication varied by parity. Among women with failure to progress, 42.6% of primiparous women and 33.5% of multiparous women never progressed beyond 5cm of dilation prior to delivery. Among women who reached the second stage of labor, 17.3% underwent cesarean delivery for arrest of descent before 2 hours and only 1.1% were given a trial of operative vaginal delivery. Of all primary cesarean deliveries, 45.6% were performed on primiparous women at term with a singleton fetus in cephalic presentation. Using 6 cm as the cutoff for active labor, allowing adequate time for the second stage of labor, and encouraging operative vaginal delivery, when appropriate, may be important strategies to reduce the primary cesarean delivery rate. These actions may be particularly important in the primiparous woman at term with a singleton fetus in cephalic presentation.