Changes in maternal characteristics and obstetric practice and recent increases in primary cesarean delivery

被引:150
作者
Joseph, KS
Young, DC
Dodds, L
O'Connell, CM
Allen, VM
Chandra, S
Allen, AC
机构
[1] Dalhousie Univ, Fac Med, Perinatal Epidemiol Res Unit, Dept Obstet & Gynecol, Halifax, NS, Canada
[2] Dalhousie Univ, Fac Med, Dept Pediat, Halifax, NS, Canada
[3] Dalhousie Univ, Fac Med, Div Maternal Fetal Med, Dept Obstet & Gynecol, Halifax, NS, Canada
关键词
D O I
10.1016/S0029-7844(03)00620-3
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: To estimate the contribution of changes in maternal characteristics (namely, age, parity, prepregnancy weight, weight gain in pregnancy, smoking status) and obstetric practice (namely, labor induction, epidural anesthesia, delivery by an obstetrician, midpelvic forceps delivery) to recent increases in primary cesarean delivery rates. METHODS: We studied all deliveries in Nova Scotia, Canada, between 1988 and 2000 after excluding women who had a previous cesarean delivery (n = 127,564). Logistic regression was used to study the effect of changes in maternal characteristics and obstetric practice on primary cesarean delivery rates. The effect of changes in midpelvic forceps delivery was examined through ecologic Poisson regression. RESULTS: Primary cesarean delivery rates increased from 13.4% of deliveries in 1988 to 17.5% in 2000. This was due to increases in cesarean deliveries for dystocia. (14% increase), breech (24% increase), suspected fetal distress (21% increase), hypertension (47% increase), and miscellaneous indications (73% increase). Adjustment for maternal characteristics reduced the temporal increase in primary cesarean delivery rates between 1988-1991 and 1998-2000 from 21% (95% confidence interval [CI] 16%,25%) to 2% (95% CI -2%, 7%). Additional adjustment for obstetric practice factors further reduced period effects. Midpelvic forceps delivery was significantly and negatively associated with primary cesarean delivery (P = .001). CONCLUSION: Recent increases in primary cesarean delivery rates are a consequence of changes in maternal characteristics. Obstetric practice, which has altered due to changes in maternal characteristics and concerns related to fetal and maternal safety, has also contributed to increases in primary cesarean delivery. (C) 2003 by The American College of Obstetricians and Gynecologists.
引用
收藏
页码:791 / 800
页数:10
相关论文
共 33 条
[1]   Obstetricians' personal choice and mode of delivery [J].
AlMufti, R ;
McCarthy, A ;
Fisk, NM .
LANCET, 1996, 347 (9000) :544-544
[2]  
*AM COLL ONST GYN, 1994, ACOG TECHN B, V196
[3]  
[Anonymous], 1985, LANCET, V2, P436
[4]  
[Anonymous], 2000, COCHRANE DB SYST REV, DOI [10.1002/14651858.CD000331, DOI 10.1002/14651858.CD000331]
[5]   Pregnancy complications and outcomes among overweight and obese nulliparous women [J].
Baeten, JM ;
Bukusi, EA ;
Lambe, M .
AMERICAN JOURNAL OF PUBLIC HEALTH, 2001, 91 (03) :436-440
[6]   DELAYED CHILDBEARING AND THE OUTCOME OF PREGNANCY [J].
BERKOWITZ, GS ;
SKOVRON, ML ;
LAPINSKI, RH ;
BERKOWITZ, RL .
NEW ENGLAND JOURNAL OF MEDICINE, 1990, 322 (10) :659-664
[7]   Factors associated with preterm births in Southeast Brazil: a comparison of two birth cohorts born 15 years apart [J].
Bettiol, H ;
Rona, RJ ;
Chinn, S ;
Goldani, M ;
Barbieri, MA .
PAEDIATRIC AND PERINATAL EPIDEMIOLOGY, 2000, 14 (01) :30-38
[8]   Pregnancy outcome at age 40 and older [J].
Bianco, A ;
Stone, J ;
Lynch, L ;
Lapinski, R ;
Berkowitz, G ;
Berkowitz, RL .
OBSTETRICS AND GYNECOLOGY, 1996, 87 (06) :917-922
[9]   The preterm prediction study: Association of cesarean delivery with increases in maternal weight and body mass index [J].
Brost, BC ;
Goldenberg, RL ;
Mercer, BM ;
Iams, JD ;
Meis, PJ ;
Moawad, AH ;
Newman, RB ;
Miodovnik, M ;
Caritis, SN ;
Thurnau, GR ;
Bottoms, SF ;
Das, A ;
McNellis, D .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1997, 177 (02) :333-337
[10]   Obstacles to reducing cesarean rates in a low-cesarean setting: The effect of maternal age, height, and weight [J].
Cnattingius, R ;
Cnattingius, S ;
Notzon, FC .
OBSTETRICS AND GYNECOLOGY, 1998, 92 (04) :501-506