Varying gestational age patterns in cesarean delivery: an international comparison

BMC Pregnancy and Childbirth

Jennifer Zeitlin⁴  James Chalmers⁶  Luule Sakkeus⁵  Petr Velebil⁷  Jan Nijhuis²  Nicholas Lack³  Katarzyna Szamotulska⁸  Mika Gissler^1,11  Ashna Mohangoo⁹  Francisco Bolumar^1,10  Kari Klungsøyr¹  Nicolas Drewniak⁴  Béatrice Blondel⁴  Marie Delnord⁴ 

[1] Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway;Department of Obstetrics and Gynaecology, MUMC, Grow school for oncology and developmental biology, Maastricht, The Netherlands;BAQ, Bavarian Institute for Quality Assurance, Department of Methods and Perinatology, Munich, Germany;INSERM UMR1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), DHU Risks in pregnancy, Paris Descartes University, Port Royal Maternity Unit, 53 Avenue de l'Observatoire, Paris, 75014, France;Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia;Information Services Division, NHS National Services Scotland, Edinburgh, UK;Institute for the Care of Mother and Child, Prague, Czech Republic;Department of Epidemiology, National Research Institute of Mother and Child, Warsaw, Poland;Department Child Health, TNO Netherlands Organization for Applied Scientific Research, Leiden, The Netherlands;Department of Public Health Sciences, University of Alcalá, Madrid, Spain;NHV Nordic School of Public Health, Gothenburg, Sweden

关键词: Euro-Peristat;    Mode of delivery;    Plurality;    Gestational age;    Cross-national comparisons;    Cesarean delivery (CD);   

Others  :  1125478
DOI  :  10.1186/1471-2393-14-321

 received in 2014-05-07, accepted in 2014-09-04,  发布年份 2014

【 摘 要 】

Background

While international variations in overall cesarean delivery rates are well documented, less information is available for clinical sub-groups. Cesarean data presented by subgroups can be used to evaluate uptake of cesarean reduction policies or to monitor delivery practices for high and low risk pregnancies based on new scientific evidence. We studied differences and patterns in cesarean delivery rates by multiplicity and gestational age in Europe and the United States.

Methods

This study used routine aggregate data from 17 European countries and the United States on the number of singleton and multiple live births with cesarean versus vaginal delivery by week of gestation in 2008. Overall and gestation-specific cesarean delivery rates were analyzed. We computed rate differences to compare mode of delivery (cesarean vs vaginal birth) between selected gestational age groups and studied associations between rates in these subgroups namely: very preterm (26–31 weeks GA), moderate preterm (32–36 weeks GA), near term (37–38 weeks GA), term (39–41 weeks GA) and post-term (42+ weeks GA) births, using Spearman’s rank tests.

Results

High variations in cesarean rates for singletons and multiples were observed everywhere. Rates for singletons varied from 15% in The Netherlands and Slovenia, to over 30% in the US and Germany. In singletons, rates were highest for very preterm births and declined to a nadir at 40 weeks of gestation, ranging from 8.0% in Sweden and Norway, to 22.5% in the US. These patterns differed across countries; the average rate difference between very preterm and term births was 43 percentage points, but ranged from 14% to 61%. High variations in rate differences were also observed for near term versus term births. For multiples, rates declined by gestational age in some countries, whereas in others rates were similar across all weeks of gestation. Countries’ overall cesarean rates were highly correlated with gestation-specific subgroup rates, except for very preterm births.

Conclusions

Gestational age patterns in cesarean delivery were heterogeneous across countries; these differences highlight areas where consensus on best practices is lacking and could be used in developing strategies to reduce cesareans.

【 授权许可】

   
2014 Delnord et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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