Intervention thresholds and cesarean section rates

a time-trends analysis

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: In order 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 was 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 to 22.3) hours to 13.1 (9.6 to 16.9) hours before first stage CS and from 17.1 (12.6 to 22.3) to 15.3 (11.5 to 19.1) hours before second stage CS, p<0.001. The proportion of CS for suspected fetal distress performed with evidence of fetal acidosis reduced from 23.4% (98/418) to 17.4% (106/608) per quintile, p<0.01. Neonatal unit admission (adj. OR 1.99, 95% CI 1.85-2.14) was more likely following unplanned CS compared with vaginal births. Birth trauma was less likely following both unplanned (OR 0.48, 95% CI 0.39-0.60) and planned (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. This article is protected by copyright. All rights reserved.

Original languageEnglish
Pages (from-to)1257-1266
Number of pages10
JournalActa Obstetricia et Gynecologica Scandinavica
Volume97
Issue number10
Early online date14 Jun 2018
DOIs
Publication statusPublished - Oct 2018

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Cesarean Section
Fetal Distress
Parturition
Term Birth
Wounds and Injuries
Chi-Square Distribution
Acidosis
Logistic Models
Databases

Keywords

  • Journal Article
  • cesarean
  • intrapartum
  • clinical threshold

Cite this

@article{beb70c247eea4ec6b6a6f853476ea511,
title = "Intervention thresholds and cesarean section rates: a time-trends analysis",
abstract = "INTRODUCTION: In order 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 was 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 to 22.3) hours to 13.1 (9.6 to 16.9) hours before first stage CS and from 17.1 (12.6 to 22.3) to 15.3 (11.5 to 19.1) hours before second stage CS, p<0.001. The proportion of CS for suspected fetal distress performed with evidence of fetal acidosis reduced from 23.4{\%} (98/418) to 17.4{\%} (106/608) per quintile, p<0.01. Neonatal unit admission (adj. OR 1.99, 95{\%} CI 1.85-2.14) was more likely following unplanned CS compared with vaginal births. Birth trauma was less likely following both unplanned (OR 0.48, 95{\%} CI 0.39-0.60) and planned (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. This article is protected by copyright. All rights reserved.",
keywords = "Journal Article, cesarean, intrapartum, clinical threshold",
author = "Anna Rose and Raja, {Edwin Amalraj} and Sohinee Bhattacharya and Mairead Black",
note = "Funding information A.R. performed this unfunded study as part of an intercalated Bachelor of Medical Science degree.",
year = "2018",
month = "10",
doi = "10.1111/aogs.13409",
language = "English",
volume = "97",
pages = "1257--1266",
journal = "Acta Obstetricia et Gynecologica Scandinavica",
issn = "0001-6349",
publisher = "Wiley-Blackwell",
number = "10",

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TY - JOUR

T1 - Intervention thresholds and cesarean section rates

T2 - a time-trends analysis

AU - Rose, Anna

AU - Raja, Edwin Amalraj

AU - Bhattacharya, Sohinee

AU - Black, Mairead

N1 - Funding information A.R. performed this unfunded study as part of an intercalated Bachelor of Medical Science degree.

PY - 2018/10

Y1 - 2018/10

N2 - INTRODUCTION: In order 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 was 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 to 22.3) hours to 13.1 (9.6 to 16.9) hours before first stage CS and from 17.1 (12.6 to 22.3) to 15.3 (11.5 to 19.1) hours before second stage CS, p<0.001. The proportion of CS for suspected fetal distress performed with evidence of fetal acidosis reduced from 23.4% (98/418) to 17.4% (106/608) per quintile, p<0.01. Neonatal unit admission (adj. OR 1.99, 95% CI 1.85-2.14) was more likely following unplanned CS compared with vaginal births. Birth trauma was less likely following both unplanned (OR 0.48, 95% CI 0.39-0.60) and planned (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. This article is protected by copyright. All rights reserved.

AB - INTRODUCTION: In order 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 was 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 to 22.3) hours to 13.1 (9.6 to 16.9) hours before first stage CS and from 17.1 (12.6 to 22.3) to 15.3 (11.5 to 19.1) hours before second stage CS, p<0.001. The proportion of CS for suspected fetal distress performed with evidence of fetal acidosis reduced from 23.4% (98/418) to 17.4% (106/608) per quintile, p<0.01. Neonatal unit admission (adj. OR 1.99, 95% CI 1.85-2.14) was more likely following unplanned CS compared with vaginal births. Birth trauma was less likely following both unplanned (OR 0.48, 95% CI 0.39-0.60) and planned (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. This article is protected by copyright. All rights reserved.

KW - Journal Article

KW - cesarean

KW - intrapartum

KW - clinical threshold

U2 - 10.1111/aogs.13409

DO - 10.1111/aogs.13409

M3 - Article

VL - 97

SP - 1257

EP - 1266

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

SN - 0001-6349

IS - 10

ER -