Trends in maternal request Cesarean delivery from 1991 to 2004
Trends in maternal request Cesarean delivery from 1991 to 2004
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DOI：
10.1097/01.aog.0000242564.79349.b7
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发表时间：
2006-12-01
影响因子：
7.2
通讯作者：
Tanfer, Koray
中科院分区：
文献类型：
--
作者：
Gossman, Ginger L.;Joesch, Jutta M.;Tanfer, Koray
目的：回顾1991年至2004年间美国产妇要求剖宫产的定义和术语，并估计剖宫产的百分比。方法：使用1991-2004年全国医院出院调查数据（N=458,767）确定要求剖宫产的产妇。在排除有剖宫产史的妇女、分娩过的妇女和有分娩风险的妇女后，仍有2394名潜在的产妇要求剖宫产。根据公认的方案确定指示的风险。结果：产妇请求剖宫产有两个特点：1)分娩前剖宫产和2)无医学条件下存在分娩风险的剖宫产。风险要么绝对不存在，要么相对不存在。1991-2004年期间，0.20%的活产婴儿分娩妇女和1.34%的初次剖宫产分娩妇女在出院记录中没有列出任何医疗条件。据估计，分娩活婴的产妇在无特定风险的情况下要求剖宫产的比例为0.75%，初次剖宫产的产妇为5.03%。产妇要求无任何风险的剖宫产在1999年达到高峰。在没有特定风险指示的情况下要求剖宫产的产妇在2004年达到顶峰。结论：我们的估计受到三个因素的影响：1)对产妇要求剖宫产的定义缺乏一致，2)医疗编码实践的变化，以及3)医生对医疗条件的反应的变化。为了有效和可靠地估计产妇要求剖宫产需要一个经验上易于处理的标准定义。
OBJECTIVE: To review definitions and terminology for and to estimate percentages of maternal request cesarean deliveries in the United States between 1991 and 2004.METHODS: National Hospital Discharge Survey data 1991-2004 (N=458,767) were used to identify maternal request cesarean deliveries. After excluding women with a history of cesarean delivery, women who labored, and women with indicated risks against labor, 2,394 potential maternal request cesarean deliveries remained. Indicated risks were identified with a recognized protocol.RESULTS: Maternal request cesarean deliveries have two properties: 1) cesarean delivery before labor and 2) cesarean delivery in the absence of medical conditions presenting a risk for labor. Risk is either absolutely absent or it is relatively absent. In 1991-2004, 0.20% of women who delivered live infants and 1.34% of women who delivered by primary cesarean delivery did so without any medical conditions listed on their hospital discharge record. Estimates for maternal request cesarean deliveries without certain indicated risks were 0.75% for women who delivered live infants and 5.03% for women who delivered by primary cesarean delivery. Maternal request cesarean deliveries without any indicated risk peaked in 1999 for women who delivered live infants. Maternal request cesarean deliveries without certain indicated risks crested in 2004.CONCLUSION: Our estimates were affected by three factors: 1) lack of agreement on a definition of maternal request cesarean deliveries, 2) changes in medical coding practices, and 3) changes in physician response to medical conditions. To validly and reliably estimate maternal request cesarean deliveries requires an empirically tractable, standard definition.