Contribution of Select Maternal Groups to Temporal Trends in Rates of Caesarean Section
Contribution of Select Maternal Groups to Temporal Trends in Rates of Caesarean Section
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DOI：
10.1016/s1701-2163(16)34566-2
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发表时间：
2010-07-01
影响因子：
1.8
通讯作者：
O'Connell, Colleen M.
中科院分区：
文献类型：
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作者：
Allen, Victoria M.;Baskett, Thomas F.;O'Connell, Colleen M.
目的：估计选择产妇群体的时间趋势剖腹产（CS）rate.Methods：使用新斯科舍省Atlee围产期数据库，所有交付CS在24年期间，从1984年至2007年，在妇女医院，IWK健康中心确定的贡献。根据产次（未产妇/经产妇）、多胎（单胎/多胎）、先露（头位/臀位/横位）、胎龄（足月/早产）、既往CS病史（既往CS/无既往CS）和分娩（自然分娩/引产/无分娩），将CS分娩分为多组。每组的CS率和每组对总体CS率的贡献被确定为三个8年的时期。随着时间的推移，在每组CS的风险，占确定的母亲，胎儿和产科实践因素，进行了评估，使用logistic regression.Results：在113 016交付，23 232（20.6%）被确定为交付CS符合纳入和排除标准。CS率从1984 - 1991年的16.8%上升到2000 - 2007年的26.8%（P < 0.001）。在上一个研究阶段（2000-2007年），对总体CS发生率贡献最大的是单胎头位足月妊娠伴自然分娩或引产的未经产女性;单胎头位足月妊娠伴既往CS的女性;臀位女性。调整后的分析解释了一些CS率的增加，并表现出降低风险others.Conclusion：只有一些暂时增加的CS率在选择产妇组调整混杂变量后仍然增加。确定潜在的可改变的产妇风险因素，重新评估未经产妇女的引产指征和技术，为剖腹产后阴道分娩提供临床服务，以及为选定的臀位进行头外倒转，这些都是重要的临床管理领域，可以考虑安全地降低剖腹产率。
Objective: To estimate the contribution of select maternal groups to temporal trends in Caesarean section (CS) rates.Methods: Using the Nova Scotia Atlee Perinatal Database, all deliveries by CS during the 24-year period from 1984 to 2007, at the Women's Hospital, IWK Health Centre were identified. Deliveries by CS were classified into groups using parity (nullipara/multipara), plurality (singleton/multiple), presentation (cephalic/breech/transverse), gestational age (term/preterm), history of previous CS (previous CS/no previous CS), and labour (spontaneous/induced/no labour). CS rates in each group and the contribution of each group to the overall CS rate was determined for three eight-year epochs. The risk of CS in each group over time, accounting for identified maternal, fetal, and obstetric practice factors, was evaluated using logistic regression.Results: Of 113 016 deliveries, 23 232 (20.6%) were identified as deliveries by CS meeting the inclusion and exclusion criteria. The CS rate rose from 16.8% in 1984 to 1991 to 26.8% in 2000 to 2007 (P < 0.001). The biggest contributors to the overall CS rate in the last study epoch (2000-2007) were nulliparous women with singleton, cephalic, term pregnancies with spontaneous or induced labour; women with singleton, cephalic, term pregnancies with previous CS; and women with breech presentation. Adjusted analyses explained some increases in the rate of CS and demonstrated reduced risks in others.Conclusion: Only some temporally increased CS rates in select maternal groups remain increased after adjusting for confounding variables. The identification of potentially modifiable maternal risk factors, re-evaluation of the indications and techniques for induction of labour in nulliparous women, provision of clinical services for vaginal birth after Caesarean section, and external cephalic version for selected breech presentation are important clinical management areas to consider for safely lowering the Caesarean section rate.