Open AccessIntervention thresholds and cesarean section rates: A time‐trends analysis
Author(s) -
Rose Anna,
Raja Edwin Amalraj,
Bhattacharya Sohinee,
Black Mairead
Publication year - 2018
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.13409
Subject(s) - medicine , fetal distress , population , logistic regression , obstetrics , confidence interval , pregnancy , demography , fetus , genetics , environmental health , biology , sociology
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.