Trends in operative delivery rates

Czech version

Authors: M. Větr
Authors‘ workplace: Gynekologicko porodnická klinika FN a LF UP Olomouc, přednosta doc. MUDr. R. Pilka, Ph. D.
Published in: Ceska Gynekol 2009; 74(5): 355-359

Overview

Objective:
The aim of this study was to identify trends in operative vaginal delivery rates and caesarean sections at Faculty Hospital in Olomouc and comparing with mean results of the Czech republic.

Design:
Retrospective epidemiological study.

Setting:
Gynaecology and Obstetrics Clinic Medical Faculty Palacky University and Faculty Hospital in Olomouc.

Methods:
Analysis of data drawn from obstetric medical records from 1. 1. 1993 to 31. 12. 2008 – rating the frequency, evolutionary trends and associated risk factors.

Results:
In this time period 26 679 children born, by caesarean section 5 916 (22,2%), ventouse 759 (2,8 % ) and forceps 526 ( 2,0%). The frequency of vaginal operations is higher than the average of the Czech Republic and from second half 90s of the 20th century no more increased. For caesarean section, however, is an upward trend (P for trend = 0.035, Cox - Stuart test). The increasing proportion of complex of 4 risk factors on the frequency of caesareans: 1 low birth weight below 2.5 kg (32.2%), 2 multiple pregnancy (18%), 3 caesareans in history (15.5%), 4 mothers over the age of 35 years (11.2%). Cumulative share of all four factors in the total number of abdominal delivery has reached a mean of 52.91% (95% CI 49,58-56,24), median = 53.75 (97.9% CI 48,64-57,32).

Conclusion:
Analysis of the development of operational termination of pregnancy confirms the significantly higher frequency of operational interventions in Olomouc compared to an average of the Czech Republic. Changes in risk profile of patients (often referred to the demographic factors) is not enough to explain the causes of the rising frequency of caesareans. The increase of invasive obstetrics undoubtedly contributes to changes in obstetric practice.

Key words:
forceps, ventouse extraction, caesarean section, trends, risk factors.

Sources

1. Aelvoet, W., Windey, F., Molenberghs, G., et al. Screening for inter - hospital differences in cesarean section rates in low-risk deliveries using administrative data: an initiative to improve the quality of care. BMC Health Serv Res, 2008, 4, 8, p. 3.

2. Benedetto, C., Marozio, L., Prandi, G., et al. Short-term maternal and neonatal outcomes by mode of delivery. A case-controlled study. Eur J Obstet Gynecol Reprod Biol, 2007, 135, 1, p. 35-40.

3. Bregar, AT., Cerar, VM., Slavec, ZZ., et al. Indications for caesarean delivery between 1955 and 2005. Wien Klin Wochenschr, 2008, 120, 23-24, p. 761-765.

4. Coleman, VH., Lawrence, H., Schulkin, J. Rising cesarean delivery rates: the impact of cesarean delivery on maternal request. Obstet Gynecol Surv, 2009, 64, 2, p. 115-119.

5. Finsen, V., Storeheier, AH., Aasland, OG. Cesarean section: Norwegian women do as obstetricians do—not as obstetricians say. Birth, 2008, 35, 2, p. 117-120.

6. Ford, J., Grewal, J., Mikolajczyk, R., et al. Primary cesarean delivery among parous women in the United States, 1990-2003. Obstet Gynecol, 2008, 112, 6. p. 1235-1241.

7. Forstholm, MM., Lidegaard, O. Cesarean section on maternal request. Ugeskr Laeger, 2009, 17, 7, p. 497-502.

8. Frischknecht, F., Brühwiler, H., Raio, L., et al. Changes in pre-pregnancy weight and weight gain during pregnancy: retrospective comparison between 1986 and 2004. Swiss Med Wkly, 2009, 139, 3-4, p. 52-55.

9. Goetzinger, KR., Macones, GA. Operative vaginal delivery: current trends in obstetrics. Womens Health (London Engl.), 2008, 4, 3, p.281-290.

10. Grant, D. Physician financial incentives and cesarean delivery: new conclusions from the healthcare cost and utilization project. J Health Econ, 2009, 28, 1, p. 244-250.

11. Chen, CS., Lin, HC., Liu, TC., et al. Urbanization and the likelihood of a cesarean section. Eur J Obstet Gynecol Reprod Biol, 2008, 141, 2, p.104-110.

12. Kaimal, AJ., Zlatnik, MG., Cheng, YW., et al. Effect of a change in policy regarding the timing of prophylactic antibiotics on the rate of postcesarean delivery surgical-site infections. Am J Obstet Gynecol, 2008, 199, 3, p. 310.

13. Kališ, V., Štěpán, J. Jr., Turek, J., et al. Porodnické operace a ruptura hráze 3. stupně a anální inkontinence. Čes Gynek, 2005, 70, 6, s. 411-418.

14. Kališ, V., Štěpán.J, Chaloupka, P., et al. Císařský řez a anální inkontinence. Čes Gynek, 2008, 73, 2. s. 112-118.

15. Křepelka, P. Císařský řez – indikace, nebo volba? Čes Gynek, 2008, 73, 5, s. 303-307.

16. Kuklina, EV., Meikle, SF., Jamieson, DJ., et al. Severe obstetric morbidity in the United States: 1998-2005. Obstet Gynecol, 2009, 113, 2, část 1, p. 293-299.

17. MacDorman, MF., Menacker, F., Declercq, E. Cesarean birth in the United States: epidemiology, trends, and outcomes. Clin Perinatol, 2008, 35, 2, p. 293-307.

18. Majoko, F., Gardener, G. Trial of instrumental delivery in theatre versus immediate caesarean section for anticipated difficult assisted births. Cochrane Database Syst Rev, 2008, 4, CD005545.

19. Mancuso, A., De Vivo, A., Fanara, G., et al. Caesarean section on request: are there loco-regional factors influencing maternal choice? An Italian experience. J Obstet Gynaecol, 2008, 28. 4, p. 382-385.

20. Pasupathy, D., Wood, AM., Pell, JP., et al. Time trend in the risk of delivery-related perinatal and neonatal death associated with breech presentation at term. Int J Epidemiol, 2009, 38, 2, p. 490-498.

21. Štembera, Z., Velebil, P. Hlavní úkoly české perinatologie na začátku 21. století. Čes Gynek, 2003, 68, 6, s. 377-384.

22. Štembera, Z., Velebil, P. Analýza výsledků perinatologické péče v ČR. XXVI. Celostátní konference Sekce perinatální medicíny ČGPS, ČLS JEP. Ostrava 22.-.24. dubna 2009.

23. Tita, AT., Landon, MB., Spong, CY., et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med, 2009, 360, 2, p. 111-120.

24. Větr, M. Rizikové faktory porodů dětí nejvyšší hmotnostní kategorie. Čes Gynek, 2005, 70, 5, s. 347-354.

25. Villar, J., Carroli, G., Zavaleta, N., et al. World Health Organization 2005 Global Survey on Maternal and Perinatal Health Research GroupMaternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ, 2007, 335, 7628, p. 1025.