Open AccessLowered national cesarean section rates after a concerted action
Author(s) -
AyresDeCampos Diogo,
Cruz Joana,
MedeirosBorges Claudia,
CostaSantos Cristina,
Vicente Lisa
Publication year - 2015
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12582
Subject(s) - medicine , vaginal delivery , obstetrics , population , incidence (geometry) , retrospective cohort study , pregnancy , infant mortality , cesarean delivery , mortality rate , surgery , environmental health , genetics , optics , physics , biology
Objective To evaluate national cesarean section ( CS ) rates and other obstetric indicators after a concerted action to reduce CS rates was undertaken in Portugal from 2010 onwards. This action was based on the transmission of information and training of healthcare professionals, together with the inclusion of CS rates as a criterion for hospital funding. Design Retrospective observational population‐based study. Setting Portugal. Population Births occurring in Portugal between 2000 and 2014. Methods Governmental sources were used to obtain data on national CS , perinatal and maternal mortality rates. Rates of instrumental vaginal delivery, vaginal birth after cesarean ( VBAC ), hypoxia‐related complications and perineal lacerations were retrieved for state‐owned hospitals. Main outcome measures CS , perinatal and maternal mortality, instrumental vaginal delivery, VBAC , hypoxia‐related complications and perineal lacerations. Results After a continuous rise between 2000 and 2009, national CS rates declined significantly over the following 5 years (36.6% vs. 33.1%, time trend p ≤ 0.001). Perinatal mortality maintained a downward trend during this period, while maternal mortality remained unchanged. Rates of instrumental vaginal delivery, VBAC and perineal lacerations increased, while the incidence of hypoxia‐related complications decreased. Conclusions A concerted action based on the transmission of information and training of healthcare professionals, together with the inclusion of CS rates as a criterion for hospital funding, was followed by a significant reduction in national CS rates, as well as an improvement in most related obstetric indicators. There may be an association between the reported intervention and the observed changes.