Shifting Patterns in Cesarean Delivery Scheduling and Timing in Oregon before and after a Statewide Hard Stop Policy.
Shifting Patterns in Cesarean Delivery Scheduling and Timing in Oregon before and after a Statewide Hard Stop Policy.
复制标题
俄勒冈州在全州硬停政策前后剖腹产计划和时间的变化。
DOI：
10.1111/1475-6773.12797
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发表时间：
2018
影响因子：
3.4
通讯作者：
Snowden,JonathanM
中科院分区：
文献类型：
--
作者：
Muoto,Ifeoma;Darney,BlairG;Lau,Bernard;Cheng,YvonneW;Tomlinson,MarkW;NeilsonJr,DuncanR;Friedman,StevenA;Rogovoy,Joanne;Caughey,AaronB;Snowden,JonathanM
目的 评估计划剖宫产和其他类别剖宫产的使用和时机，以及俄勒冈州实施限制选择性提前分娩的全州政策前后剖宫产新生儿发病率。数据来源俄勒冈州人口动态统计记录，2008-2013 年。研究设计回顾性队列研究，采用多变量逻辑回归、时间趋势回归控制和间断时间序列分析，比较不同类别剖宫产的几率以及保单前后新生儿发病率。数据收集/提取方法我们分析了俄勒冈州所有足月出生的生命统计数据（2008-2013），不包括 2011 年的出生。主要发现早期计划剖宫产的几率在保单后下降（调整后的比值比 [aOR]， 0.70；95% 置信区间 [CI]，0.66–0.74）。在保单后阶段，关于辅助新生儿通气和新生儿重症监护病房入院的结果好坏参半，回归模型表明某些类别的保单后赔率较高，但在控制时间趋势后保单后赔率较低。需要更多研究此类政策对新生儿结局的影响。
ObjectivesTo assess the use and timing of scheduled cesareans and other categories of cesarean delivery and the prevalence of neonatal morbidity among cesareans in Oregon before and after the implementation of Oregon's statewide policy limiting elective early deliveries.Data SourcesOregon vital statistics records, 2008–2013.Study DesignRetrospective cohort study, with multivariable logistic regression, regression controlling for time trends, and interrupted time series analyses, to compare the odds of different categories of cesarean delivery and the odds of neonatal morbidity pre‐ and postpolicy.Data Collection/Extraction MethodsWe analyzed vital statistics data on all term births in Oregon (2008–2013), excluding births in 2011.Principal FindingsThe odds of early‐term scheduled cesareans decreased postpolicy (adjusted odds ratio [aOR], 0.70; 95 percent confidence interval [CI], 0.66–0.74). In the postpolicy period, there were mixed findings regarding assisted neonatal ventilation and neonatal intensive care unit admission, with regression models indicating higher postpolicy odds in some categories, but lower postpolicy odds after controlling for time trends.ConclusionsOregon's hard stop policy limiting elective early‐term cesarean delivery was associated with lower odds of cesarean delivery in the category of women who were targeted by the policy; more research is needed on impact of such policies on neonatal outcomes.