What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies.
What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies.
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DOI：
10.1186/s12978-015-0043-6
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发表时间：
2015-06-21
影响因子：
3.4
通讯作者：
Gülmezoglu AM
中科院分区：
文献类型：
--
作者：
Betran AP;Torloni MR;Zhang J;Ye J;Mikolajczyk R;Deneux-Tharaux C;Oladapo OT;Souza JP;Tunçalp Ö;Vogel JP;Gülmezoglu AM
1985年，世卫组织指出，在人口水平上，剖腹产率高于10- 15%是没有道理的。虽然在随后的三十年里，全球CS率以前所未有的方式继续增加，但人们对1985年具有里程碑意义的声明的有效性表示担忧。我们进行了一项系统的回顾，以确定，批判性地评价和综合分析CS率和孕产妇，新生儿和婴儿结局之间的生态关联。在2000年至2014年期间发表的四个电子数据库中检索了生态研究，这些研究分析了CS率与孕产妇，新生儿或婴儿死亡率或发病率之间的可能关联。两名评价者独立进行研究选择、数据提取和质量评估。我们确定了11，832篇独特的引文，8项研究被纳入综述。7项研究将剖宫产率与孕产妇死亡率、5项与新生儿死亡率、4项与婴儿死亡率、2项与出生体重不足、1项与死产相关联。除一项研究外，所有研究均为横断面设计，5项研究为国家级CS率与死亡率结局的全球分析。尽管研究的总体质量是可接受的;但只有两项研究控制了社会经济因素，没有一项控制了人群的临床或人口统计学特征。在未经调整的分析中，作者发现CS率与死亡率结果之间存在强烈的负相关关系，因此，当CS率增加到一定阈值时，孕产妇、新生儿和婴儿死亡率会降低。在本综述纳入的8项研究中，该阈值为CS率在9 - 16%之间。然而，在调整了社会经济因素的两项研究中，在控制了这些混杂因素后，这种关系被削弱或消失。CS率高于9- 16%的阈值与死亡率结局的降低无关，无论如何调整。我们的研究结果可以解释为，在CS率低于这一阈值，社会经济发展可能会推动CS率和死亡率之间的生态关联。另一方面，在高于该阈值的比率下，CS和死亡率结果之间没有关联，无论调整与否。在人群水平得出更明确的结论之前，需要评估CS率和相关发病率结局之间的生态关联。本文的在线版本（doi：10.1186/s12978-015-0043-6）包含补充材料，可供授权用户使用。
In 1985, WHO stated that there was no justification for caesarean section (CS) rates higher than 10–15 % at population-level. While the CS rates worldwide have continued to increase in an unprecedented manner over the subsequent three decades, concern has been raised about the validity of the 1985 landmark statement. We conducted a systematic review to identify, critically appraise and synthesize the analyses of the ecologic association between CS rates and maternal, neonatal and infant outcomes. Four electronic databases were searched for ecologic studies published between 2000 and 2014 that analysed the possible association between CS rates and maternal, neonatal or infant mortality or morbidity. Two reviewers performed study selection, data extraction and quality assessment independently. We identified 11,832 unique citations and eight studies were included in the review. Seven studies correlated CS rates with maternal mortality, five with neonatal mortality, four with infant mortality, two with LBW and one with stillbirths. Except for one, all studies were cross-sectional in design and five were global analyses of national-level CS rates versus mortality outcomes. Although the overall quality of the studies was acceptable; only two studies controlled for socio-economic factors and none controlled for clinical or demographic characteristics of the population. In unadjusted analyses, authors found a strong inverse relationship between CS rates and the mortality outcomes so that maternal, neonatal and infant mortality decrease as CS rates increase up to a certain threshold. In the eight studies included in this review, this threshold was at CS rates between 9 and 16 %. However, in the two studies that adjusted for socio-economic factors, this relationship was either weakened or disappeared after controlling for these confounders. CS rates above the threshold of 9–16 % were not associated with decreases in mortality outcomes regardless of adjustments. Our findings could be interpreted to mean that at CS rates below this threshold, socio-economic development may be driving the ecologic association between CS rates and mortality. On the other hand, at rates higher than this threshold, there is no association between CS and mortality outcomes regardless of adjustment. The ecological association between CS rates and relevant morbidity outcomes needs to be evaluated before drawing more definite conclusions at population level. The online version of this article (doi:10.1186/s12978-015-0043-6) contains supplementary material, which is available to authorized users.
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影响因子：
3.7
作者：
Betrán AP;Vindevoghel N;Souza JP;Gülmezoglu AM;Torloni MR
通讯作者：
Torloni MR
影响因子：
168.9
作者：
Lumbiganon, Pisake;Laopaiboon, Malinee;Villar, Jose
通讯作者：
Villar, Jose
DOI：
10.1590/s1020-49892011000500001
发表时间：
2011-05-01
期刊：
Revista Panamericana de Salud Pública
影响因子：
--
作者：
Volpe, Fernando Madalena
通讯作者：
Volpe, Fernando Madalena
影响因子：
34.3
作者：
Vogel, Joshua P.;Betran, Ana Pilar;Temmerman, Marleen
通讯作者：
Temmerman, Marleen
DOI：
10.1016/j.ijgo.2006.10.010
发表时间：
2007-02-01
影响因子：
3.8
作者：
McClure, E. M.;Goldenberg, R. L.;Bann, C. M.
通讯作者：
Bann, C. M.