Intervention thresholds and cesarean section rates: A time‐trends analysis
Introduction To improve understanding of rising cesarean section (CS) rates in the UK, this study assessed the relation between clinician thresholds for performing CS for delayed labor progress or suspected fetal distress and corresponding CS rates in Aberdeen, UK. Material and methods Time‐trends a...
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| Veröffentlicht in: | Acta obstetricia et gynecologica Scandinavica 2018-10, Vol.97 (10), p.1257-1266 |
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| container_title | Acta obstetricia et gynecologica Scandinavica |
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| creator | Rose, Anna Raja, Edwin Amalraj Bhattacharya, Sohinee Black, Mairead |
| description | Introduction
To improve understanding of rising cesarean section (CS) rates in the UK, this study assessed the relation between clinician thresholds for performing CS for delayed labor progress or suspected fetal distress and corresponding CS rates in Aberdeen, UK.
Material and methods
Time‐trends analysis of term births from 1988 to 2012 in a population of nulliparous women (N = 53 745) in Aberdeen, UK, using Chi‐square test for trend, and binary logistic regression. Data were obtained from the Aberdeen Maternity and Neonatal Databank.
Results
Unplanned CS rates per quintile increased from 11.0% (1391/12 686) to 21.1% (2383/11 273) between 1988 and 2012, while planned CS rates increased from 2.7% (338/12 686) to 5.2% (591/11 273). The median duration of labor before CS for delayed progress per quintile decreased from 17.2 (IQR 12.5‐22.3) to 13.1 hours (9.6‐16.9) before first stage CS and from 17.1 (12.6‐22.3) to 15.3 (11.5‐19.1) hours before second stage CS (P |
| doi_str_mv | 10.1111/aogs.13409 |
| format | Article |
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To improve understanding of rising cesarean section (CS) rates in the UK, this study assessed the relation between clinician thresholds for performing CS for delayed labor progress or suspected fetal distress and corresponding CS rates in Aberdeen, UK.
Material and methods
Time‐trends analysis of term births from 1988 to 2012 in a population of nulliparous women (N = 53 745) in Aberdeen, UK, using Chi‐square test for trend, and binary logistic regression. Data were obtained from the Aberdeen Maternity and Neonatal Databank.
Results
Unplanned CS rates per quintile increased from 11.0% (1391/12 686) to 21.1% (2383/11 273) between 1988 and 2012, while planned CS rates increased from 2.7% (338/12 686) to 5.2% (591/11 273). The median duration of labor before CS for delayed progress per quintile decreased from 17.2 (IQR 12.5‐22.3) to 13.1 hours (9.6‐16.9) before first stage CS and from 17.1 (12.6‐22.3) to 15.3 (11.5‐19.1) hours before second stage CS (P < .001). The proportion of CS for suspected fetal distress performed with evidence of fetal acidosis declined from 23.4% (98/418) to 17.4% (106/608) per quintile (P < .01). Neonatal unit admission (adjusted OR 1.99, 95% CI 1.85‐2.14) was more likely following unplanned CS than vaginal births. Birth trauma was less likely following both unplanned (adjusted OR 0.48, 95% CI 0.39‐0.60) and planned (adjusted OR 0.33, 95% CI 0.18‐0.63) CS.
Conclusion
Increased CS rates can be partly attributed to lowered clinical thresholds for intrapartum CS. Higher CS rates are associated with less birth trauma for the offspring.</description><identifier>ISSN: 0001-6349</identifier><identifier>EISSN: 1600-0412</identifier><identifier>DOI: 10.1111/aogs.13409</identifier><identifier>PMID: 29900544</identifier><language>eng</language><publisher>United States: John Wiley & Sons, Inc</publisher><subject>Acidosis ; Birth injuries ; cesarean ; Cesarean section ; Childbirth & labor ; clinical threshold ; Health risk assessment ; intrapartum ; Trends</subject><ispartof>Acta obstetricia et gynecologica Scandinavica, 2018-10, Vol.97 (10), p.1257-1266</ispartof><rights>2018 Nordic Federation of Societies of Obstetrics and Gynecology</rights><rights>2018 Nordic Federation of Societies of Obstetrics and Gynecology.</rights><rights>Copyright © 2018 Acta Obstetricia et Gynecologica Scandinavica</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3939-240f4e4e9c7d98f1d838d05a9df6ee458679739936e4a4066d4f2a638b539a103</citedby><cites>FETCH-LOGICAL-c3939-240f4e4e9c7d98f1d838d05a9df6ee458679739936e4a4066d4f2a638b539a103</cites><orcidid>0000-0002-2358-5860 ; 0000-0002-6841-8601 ; 0000-0003-0853-9724</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Faogs.13409$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Faogs.13409$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29900544$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rose, Anna</creatorcontrib><creatorcontrib>Raja, Edwin Amalraj</creatorcontrib><creatorcontrib>Bhattacharya, Sohinee</creatorcontrib><creatorcontrib>Black, Mairead</creatorcontrib><title>Intervention thresholds and cesarean section rates: A time‐trends analysis</title><title>Acta obstetricia et gynecologica Scandinavica</title><addtitle>Acta Obstet Gynecol Scand</addtitle><description>Introduction
To improve understanding of rising cesarean section (CS) rates in the UK, this study assessed the relation between clinician thresholds for performing CS for delayed labor progress or suspected fetal distress and corresponding CS rates in Aberdeen, UK.
Material and methods
Time‐trends analysis of term births from 1988 to 2012 in a population of nulliparous women (N = 53 745) in Aberdeen, UK, using Chi‐square test for trend, and binary logistic regression. Data were obtained from the Aberdeen Maternity and Neonatal Databank.
Results
Unplanned CS rates per quintile increased from 11.0% (1391/12 686) to 21.1% (2383/11 273) between 1988 and 2012, while planned CS rates increased from 2.7% (338/12 686) to 5.2% (591/11 273). The median duration of labor before CS for delayed progress per quintile decreased from 17.2 (IQR 12.5‐22.3) to 13.1 hours (9.6‐16.9) before first stage CS and from 17.1 (12.6‐22.3) to 15.3 (11.5‐19.1) hours before second stage CS (P < .001). The proportion of CS for suspected fetal distress performed with evidence of fetal acidosis declined from 23.4% (98/418) to 17.4% (106/608) per quintile (P < .01). Neonatal unit admission (adjusted OR 1.99, 95% CI 1.85‐2.14) was more likely following unplanned CS than vaginal births. Birth trauma was less likely following both unplanned (adjusted OR 0.48, 95% CI 0.39‐0.60) and planned (adjusted OR 0.33, 95% CI 0.18‐0.63) CS.
Conclusion
Increased CS rates can be partly attributed to lowered clinical thresholds for intrapartum CS. Higher CS rates are associated with less birth trauma for the offspring.</description><subject>Acidosis</subject><subject>Birth injuries</subject><subject>cesarean</subject><subject>Cesarean section</subject><subject>Childbirth & labor</subject><subject>clinical threshold</subject><subject>Health risk assessment</subject><subject>intrapartum</subject><subject>Trends</subject><issn>0001-6349</issn><issn>1600-0412</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp90M9Kw0AQBvBFFFurFx9AAl5ESJ3NbjZZb6VoLRR6UM_LNpnYlPypu4nSm4_gM_okbpvqwYN7GZb58TF8hJxTGFL3bnT9YoeUcZAHpE8FgA-cBoekDwDUF4zLHjmxduV-QcTjY9ILpAQIOe-T2bRq0Lxh1eR15TVLg3ZZF6n1dJV6CVptUFeexWS3N7pBe-uNvCYv8evjszFY7awuNja3p-Qo04XFs_0ckOf7u6fxgz-bT6bj0cxPmGTSDzhkHDnKJEplnNE0ZnEKoZZpJhB5GItIRkxKJpBrDkKkPAu0YPEiZFJTYANy1eWuTf3aom1UmdsEi0JXWLdWBRCGIqBUMEcv_9BV3Rp3r1MUKA050Nip604lprbWYKbWJi-12SgKatux2nasdh07fLGPbBclpr_0p1QHaAfe8wI3_0Sp0Xzy2IV-A4FqhjE</recordid><startdate>201810</startdate><enddate>201810</enddate><creator>Rose, Anna</creator><creator>Raja, Edwin Amalraj</creator><creator>Bhattacharya, Sohinee</creator><creator>Black, Mairead</creator><general>John Wiley & Sons, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2358-5860</orcidid><orcidid>https://orcid.org/0000-0002-6841-8601</orcidid><orcidid>https://orcid.org/0000-0003-0853-9724</orcidid></search><sort><creationdate>201810</creationdate><title>Intervention thresholds and cesarean section rates: A time‐trends analysis</title><author>Rose, Anna ; Raja, Edwin Amalraj ; Bhattacharya, Sohinee ; Black, Mairead</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3939-240f4e4e9c7d98f1d838d05a9df6ee458679739936e4a4066d4f2a638b539a103</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Acidosis</topic><topic>Birth injuries</topic><topic>cesarean</topic><topic>Cesarean section</topic><topic>Childbirth & labor</topic><topic>clinical threshold</topic><topic>Health risk assessment</topic><topic>intrapartum</topic><topic>Trends</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rose, Anna</creatorcontrib><creatorcontrib>Raja, Edwin Amalraj</creatorcontrib><creatorcontrib>Bhattacharya, Sohinee</creatorcontrib><creatorcontrib>Black, Mairead</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Acta obstetricia et gynecologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rose, Anna</au><au>Raja, Edwin Amalraj</au><au>Bhattacharya, Sohinee</au><au>Black, Mairead</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intervention thresholds and cesarean section rates: A time‐trends analysis</atitle><jtitle>Acta obstetricia et gynecologica Scandinavica</jtitle><addtitle>Acta Obstet Gynecol Scand</addtitle><date>2018-10</date><risdate>2018</risdate><volume>97</volume><issue>10</issue><spage>1257</spage><epage>1266</epage><pages>1257-1266</pages><issn>0001-6349</issn><eissn>1600-0412</eissn><abstract>Introduction
To improve understanding of rising cesarean section (CS) rates in the UK, this study assessed the relation between clinician thresholds for performing CS for delayed labor progress or suspected fetal distress and corresponding CS rates in Aberdeen, UK.
Material and methods
Time‐trends analysis of term births from 1988 to 2012 in a population of nulliparous women (N = 53 745) in Aberdeen, UK, using Chi‐square test for trend, and binary logistic regression. Data were obtained from the Aberdeen Maternity and Neonatal Databank.
Results
Unplanned CS rates per quintile increased from 11.0% (1391/12 686) to 21.1% (2383/11 273) between 1988 and 2012, while planned CS rates increased from 2.7% (338/12 686) to 5.2% (591/11 273). The median duration of labor before CS for delayed progress per quintile decreased from 17.2 (IQR 12.5‐22.3) to 13.1 hours (9.6‐16.9) before first stage CS and from 17.1 (12.6‐22.3) to 15.3 (11.5‐19.1) hours before second stage CS (P < .001). The proportion of CS for suspected fetal distress performed with evidence of fetal acidosis declined from 23.4% (98/418) to 17.4% (106/608) per quintile (P < .01). Neonatal unit admission (adjusted OR 1.99, 95% CI 1.85‐2.14) was more likely following unplanned CS than vaginal births. Birth trauma was less likely following both unplanned (adjusted OR 0.48, 95% CI 0.39‐0.60) and planned (adjusted OR 0.33, 95% CI 0.18‐0.63) CS.
Conclusion
Increased CS rates can be partly attributed to lowered clinical thresholds for intrapartum CS. Higher CS rates are associated with less birth trauma for the offspring.</abstract><cop>United States</cop><pub>John Wiley & Sons, Inc</pub><pmid>29900544</pmid><doi>10.1111/aogs.13409</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-2358-5860</orcidid><orcidid>https://orcid.org/0000-0002-6841-8601</orcidid><orcidid>https://orcid.org/0000-0003-0853-9724</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley Online Library Journals Frontfile Complete |
| subjects | Acidosis Birth injuries cesarean Cesarean section Childbirth & labor clinical threshold Health risk assessment intrapartum Trends |
| title | Intervention thresholds and cesarean section rates: A time‐trends analysis |
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