Indications for Cesarean Delivery in Mexico: Evaluation of Appropriate Use and Justification
Background Cesarean delivery is one of the most widely used surgical interventions in Latin America and in many cases it is performed with no clear medical indication. Our objective was to analyze the relationship between reported indications for a cesarean and support for that indication in the cli...
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| Veröffentlicht in: | Birth (Berkeley, Calif.) Calif.), 2017-03, Vol.44 (1), p.78-85 |
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| creator | Aranda‐Neri, Juan Carlos Suárez‐López, Leticia DeMaria, Lisa M. Walker, Dilys |
| description | Background
Cesarean delivery is one of the most widely used surgical interventions in Latin America and in many cases it is performed with no clear medical indication. Our objective was to analyze the relationship between reported indications for a cesarean and support for that indication in the clinical record in four Mexican hospitals, during the 2006–2007 period.
Methods
The data are from 604 (37.1%) women from a total of 1,625 who were admitted to the hospital in labor, and who gave birth through cesarean. Multivariate logistical regression analysis was used to explore the association between indications for clinically justified or unjustified surgery and other clinical and sociodemographic variables.
Results
Supporting clinical information for indications of cesarean delivery were found in only 45 percent of the cases considered. The adjusted statistical analysis showed that the variables associated with an unjustified indication for cesarean were: not having had a prior birth (OR 1.84 [95% CI 1.16–2.89]), having a maximum cervical dilation of 4 centimeters or less at time of cesarean (OR 2.44 [95% CI 1.53–3.87]), and having received care in a private hospital (OR 6.11 [95% CI 1.90–19.57]).
Discussion
The indications for cesarean related to labor dynamics were those least supported. Not having had a prior birth poses the greatest risk of having a poorly supported indication for a cesarean delivery. It would be prudent to institute audits, and greater requirements for and surveillance of documentation for cesarean delivery indications. |
| doi_str_mv | 10.1111/birt.12259 |
| format | Article |
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Cesarean delivery is one of the most widely used surgical interventions in Latin America and in many cases it is performed with no clear medical indication. Our objective was to analyze the relationship between reported indications for a cesarean and support for that indication in the clinical record in four Mexican hospitals, during the 2006–2007 period.
Methods
The data are from 604 (37.1%) women from a total of 1,625 who were admitted to the hospital in labor, and who gave birth through cesarean. Multivariate logistical regression analysis was used to explore the association between indications for clinically justified or unjustified surgery and other clinical and sociodemographic variables.
Results
Supporting clinical information for indications of cesarean delivery were found in only 45 percent of the cases considered. The adjusted statistical analysis showed that the variables associated with an unjustified indication for cesarean were: not having had a prior birth (OR 1.84 [95% CI 1.16–2.89]), having a maximum cervical dilation of 4 centimeters or less at time of cesarean (OR 2.44 [95% CI 1.53–3.87]), and having received care in a private hospital (OR 6.11 [95% CI 1.90–19.57]).
Discussion
The indications for cesarean related to labor dynamics were those least supported. Not having had a prior birth poses the greatest risk of having a poorly supported indication for a cesarean delivery. It would be prudent to institute audits, and greater requirements for and surveillance of documentation for cesarean delivery indications.</description><identifier>ISSN: 0730-7659</identifier><identifier>EISSN: 1523-536X</identifier><identifier>DOI: 10.1111/birt.12259</identifier><identifier>PMID: 27779329</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adult ; appropriate use ; Caesarean section ; cesarean delivery ; Cesarean section ; Cesarean Section - statistics & numerical data ; Childbirth ; Clinical information ; Databases, Factual ; Delivery of Health Care - standards ; diagnostic techniques ; Diagnostic Techniques and Procedures ; Female ; health care deliveries ; Health risk assessment ; Hospitals ; Hospitals, Private - statistics & numerical data ; Hospitals, Public - statistics & numerical data ; Humans ; Justification ; Logistic Models ; Mexican people ; Mexico ; Mexico - epidemiology ; Multivariate Analysis ; Obstetrics ; Obstetrics - standards ; Pregnancy ; Sociodemographic aspects ; Statistical analysis ; Surgery ; Surveillance ; Women ; Young Adult</subject><ispartof>Birth (Berkeley, Calif.), 2017-03, Vol.44 (1), p.78-85</ispartof><rights>2016 Wiley Periodicals, Inc.</rights><rights>Copyright © 2017 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3909-ac51c6aa2f3db2162bb2a7b9384fcb6dbac0b04dc192737fc90096fe7fec49323</citedby><cites>FETCH-LOGICAL-c3909-ac51c6aa2f3db2162bb2a7b9384fcb6dbac0b04dc192737fc90096fe7fec49323</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fbirt.12259$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fbirt.12259$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27923,27924,30998,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27779329$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aranda‐Neri, Juan Carlos</creatorcontrib><creatorcontrib>Suárez‐López, Leticia</creatorcontrib><creatorcontrib>DeMaria, Lisa M.</creatorcontrib><creatorcontrib>Walker, Dilys</creatorcontrib><title>Indications for Cesarean Delivery in Mexico: Evaluation of Appropriate Use and Justification</title><title>Birth (Berkeley, Calif.)</title><addtitle>Birth</addtitle><description>Background
Cesarean delivery is one of the most widely used surgical interventions in Latin America and in many cases it is performed with no clear medical indication. Our objective was to analyze the relationship between reported indications for a cesarean and support for that indication in the clinical record in four Mexican hospitals, during the 2006–2007 period.
Methods
The data are from 604 (37.1%) women from a total of 1,625 who were admitted to the hospital in labor, and who gave birth through cesarean. Multivariate logistical regression analysis was used to explore the association between indications for clinically justified or unjustified surgery and other clinical and sociodemographic variables.
Results
Supporting clinical information for indications of cesarean delivery were found in only 45 percent of the cases considered. The adjusted statistical analysis showed that the variables associated with an unjustified indication for cesarean were: not having had a prior birth (OR 1.84 [95% CI 1.16–2.89]), having a maximum cervical dilation of 4 centimeters or less at time of cesarean (OR 2.44 [95% CI 1.53–3.87]), and having received care in a private hospital (OR 6.11 [95% CI 1.90–19.57]).
Discussion
The indications for cesarean related to labor dynamics were those least supported. Not having had a prior birth poses the greatest risk of having a poorly supported indication for a cesarean delivery. It would be prudent to institute audits, and greater requirements for and surveillance of documentation for cesarean delivery indications.</description><subject>Adult</subject><subject>appropriate use</subject><subject>Caesarean section</subject><subject>cesarean delivery</subject><subject>Cesarean section</subject><subject>Cesarean Section - statistics & numerical data</subject><subject>Childbirth</subject><subject>Clinical information</subject><subject>Databases, Factual</subject><subject>Delivery of Health Care - standards</subject><subject>diagnostic techniques</subject><subject>Diagnostic Techniques and Procedures</subject><subject>Female</subject><subject>health care deliveries</subject><subject>Health risk assessment</subject><subject>Hospitals</subject><subject>Hospitals, Private - statistics & numerical data</subject><subject>Hospitals, Public - statistics & numerical data</subject><subject>Humans</subject><subject>Justification</subject><subject>Logistic Models</subject><subject>Mexican people</subject><subject>Mexico</subject><subject>Mexico - epidemiology</subject><subject>Multivariate Analysis</subject><subject>Obstetrics</subject><subject>Obstetrics - standards</subject><subject>Pregnancy</subject><subject>Sociodemographic aspects</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Surveillance</subject><subject>Women</subject><subject>Young Adult</subject><issn>0730-7659</issn><issn>1523-536X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNqNkU1LxDAURYMoOo5u_AEScCNCNR9N0rjT8WtEEUTBhVCSNIFIpx2TVp1_b8YZXbgQ3-ZtDod33wVgB6NDnOZI-9AdYkKYXAEDzAjNGOVPq2CABEWZ4ExugM0YXxBCIs_5OtggQghJiRyA53FTeaM63zYRujbAkY0qWNXAM1v7Nxtm0Dfw1n540x7D8zdV918wbB08mU5DOw1edRY-RgtVU8HrPnbeLY1bYM2pOtrt5R6Cx4vzh9FVdnN3OR6d3GSGSiQzZRg2XCniaKUJ5kRrooSWtMid0bzSyiCN8spgSQQVzkiEJHdWOGvyFIMOwf7Cm-557W3syomPxta1amzbxxIXghWUFQX7B0oZp5SIuXXvF_rS9qFJQRLFC0wJStYhOFhQJrQxBuvK9JGJCrMSo3JeTzmvp_yqJ8G7S2WvJ7b6Qb_7SABeAO--trM_VOXp-P5hIf0Eut6aYQ</recordid><startdate>201703</startdate><enddate>201703</enddate><creator>Aranda‐Neri, Juan Carlos</creator><creator>Suárez‐López, Leticia</creator><creator>DeMaria, Lisa M.</creator><creator>Walker, Dilys</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>201703</creationdate><title>Indications for Cesarean Delivery in Mexico: Evaluation of Appropriate Use and Justification</title><author>Aranda‐Neri, Juan Carlos ; Suárez‐López, Leticia ; DeMaria, Lisa M. ; Walker, Dilys</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3909-ac51c6aa2f3db2162bb2a7b9384fcb6dbac0b04dc192737fc90096fe7fec49323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>appropriate use</topic><topic>Caesarean section</topic><topic>cesarean delivery</topic><topic>Cesarean section</topic><topic>Cesarean Section - statistics & numerical data</topic><topic>Childbirth</topic><topic>Clinical information</topic><topic>Databases, Factual</topic><topic>Delivery of Health Care - standards</topic><topic>diagnostic techniques</topic><topic>Diagnostic Techniques and Procedures</topic><topic>Female</topic><topic>health care deliveries</topic><topic>Health risk assessment</topic><topic>Hospitals</topic><topic>Hospitals, Private - statistics & numerical data</topic><topic>Hospitals, Public - statistics & numerical data</topic><topic>Humans</topic><topic>Justification</topic><topic>Logistic Models</topic><topic>Mexican people</topic><topic>Mexico</topic><topic>Mexico - epidemiology</topic><topic>Multivariate Analysis</topic><topic>Obstetrics</topic><topic>Obstetrics - standards</topic><topic>Pregnancy</topic><topic>Sociodemographic aspects</topic><topic>Statistical analysis</topic><topic>Surgery</topic><topic>Surveillance</topic><topic>Women</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Aranda‐Neri, Juan Carlos</creatorcontrib><creatorcontrib>Suárez‐López, Leticia</creatorcontrib><creatorcontrib>DeMaria, Lisa M.</creatorcontrib><creatorcontrib>Walker, Dilys</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Birth (Berkeley, Calif.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aranda‐Neri, Juan Carlos</au><au>Suárez‐López, Leticia</au><au>DeMaria, Lisa M.</au><au>Walker, Dilys</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Indications for Cesarean Delivery in Mexico: Evaluation of Appropriate Use and Justification</atitle><jtitle>Birth (Berkeley, Calif.)</jtitle><addtitle>Birth</addtitle><date>2017-03</date><risdate>2017</risdate><volume>44</volume><issue>1</issue><spage>78</spage><epage>85</epage><pages>78-85</pages><issn>0730-7659</issn><eissn>1523-536X</eissn><abstract>Background
Cesarean delivery is one of the most widely used surgical interventions in Latin America and in many cases it is performed with no clear medical indication. Our objective was to analyze the relationship between reported indications for a cesarean and support for that indication in the clinical record in four Mexican hospitals, during the 2006–2007 period.
Methods
The data are from 604 (37.1%) women from a total of 1,625 who were admitted to the hospital in labor, and who gave birth through cesarean. Multivariate logistical regression analysis was used to explore the association between indications for clinically justified or unjustified surgery and other clinical and sociodemographic variables.
Results
Supporting clinical information for indications of cesarean delivery were found in only 45 percent of the cases considered. The adjusted statistical analysis showed that the variables associated with an unjustified indication for cesarean were: not having had a prior birth (OR 1.84 [95% CI 1.16–2.89]), having a maximum cervical dilation of 4 centimeters or less at time of cesarean (OR 2.44 [95% CI 1.53–3.87]), and having received care in a private hospital (OR 6.11 [95% CI 1.90–19.57]).
Discussion
The indications for cesarean related to labor dynamics were those least supported. Not having had a prior birth poses the greatest risk of having a poorly supported indication for a cesarean delivery. It would be prudent to institute audits, and greater requirements for and surveillance of documentation for cesarean delivery indications.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>27779329</pmid><doi>10.1111/birt.12259</doi><tpages>8</tpages></addata></record> |
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| source | MEDLINE; Applied Social Sciences Index & Abstracts (ASSIA); Wiley Online Library All Journals |
| subjects | Adult appropriate use Caesarean section cesarean delivery Cesarean section Cesarean Section - statistics & numerical data Childbirth Clinical information Databases, Factual Delivery of Health Care - standards diagnostic techniques Diagnostic Techniques and Procedures Female health care deliveries Health risk assessment Hospitals Hospitals, Private - statistics & numerical data Hospitals, Public - statistics & numerical data Humans Justification Logistic Models Mexican people Mexico Mexico - epidemiology Multivariate Analysis Obstetrics Obstetrics - standards Pregnancy Sociodemographic aspects Statistical analysis Surgery Surveillance Women Young Adult |
| title | Indications for Cesarean Delivery in Mexico: Evaluation of Appropriate Use and Justification |
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