Open AccessCesarean delivery rates and obstetric culture – an Italian register‐based study
Author(s) -
Plevani Cristina,
Incerti Maddalena,
Del Sorbo Davide,
Pintucci Armando,
Vergani Patrizia,
Merlino Luca,
Locatelli Anna
Publication year - 2017
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.13063
Subject(s) - medicine , vaginal delivery , birth certificate , cesarean delivery , obstetrics , logistic regression , apgar score , gynecology , pregnancy , gestational age , population , genetics , environmental health , biology
Cesarean delivery rates are rising due to multiple factors, including less use of operative vaginal delivery and vaginal birth after cesarean delivery, which often reflect local obstetric practices. Objectives of the study were to analyze the relations between cesarean delivery, these practices, and perinatal outcomes. Material and methods We included all deliveries in the 72 hospitals of Lombardia, a region in northern Italy, during the year 2013. The delivery certificate was used as data source. Pearson's correlation coefficient and logistic regression were used for statistical analysis. Results We included 87 896 deliveries. The number of deliveries per hospital ranged from 140 to 6123. The rate of cesarean delivery was 28.3% (range 9.9–86.4%), operative vaginal delivery 4.7% (range 0.2–10.0%), and vaginal birth after cesarean 17.3% (range 0–79.2%). We found a significant inverse correlation between rates of overall cesarean delivery and operative vaginal delivery ( r = −0.25, p = 0.04). The correlation between rate of overall cesarean delivery and vaginal birth after cesarean was also inverse and significant ( r = −0.57, p < 0.001). There was no association between overall cesarean delivery rate and the rates of Apgar score at 5 min <7 in term and late preterm neonates ( r = −0.92, p = 0.46) and of perinatal mortality ( r = −0.19, p = 0.13), respectively. The associations were independent of hospital volume of activity. Conclusions An obstetric practice that encourages vaginal instrumental delivery in delayed second stage of labor or vaginal birth after previous cesarean delivery, could reduce the rising cesarean delivery rate. This will require a change in obstetric culture, continuing education of healthcare providers, and leadership.