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International differences in the use of obstetric interventions
1National Center for Health Statistics, US Department of Health and Human Services, Hyattsville, Md 20782.
JAMA
|June 27, 1990
Summary
Cesarean section and operative vaginal delivery rates varied significantly across 21 countries between 1975-1986. Despite rising cesarean rates for specific complications, no clear link was found between intervention rates and birth outcomes.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Global Health
Background:
- Significant international variations exist in obstetric intervention rates.
- Trends from 1975 to 1986 reveal shifts in cesarean section and operative vaginal delivery practices.
- Understanding these trends is crucial for evaluating maternal and infant care globally.
Purpose of the Study:
- To investigate and compare current levels and trends in cesarean section and operative vaginal delivery rates across multiple countries.
- To analyze the relationship between national intervention rates and birth outcomes.
- To identify potential correlations between specific obstetric interventions and labor/delivery complications.
Main Methods:
- Comparative analysis of national obstetric intervention data from 21 countries (cesarean section) and 14 countries (operative vaginal delivery) between 1975 and 1986.
- Examination of cesarean section rates for objectively diagnosed complications like multiple births and breech delivery (1980-1985).
- Correlation analysis between 1985 national intervention rates and measures of birth outcome.
Main Results:
- Wide disparities in cesarean delivery rates (7-32 per 100 deliveries) and operative vaginal delivery rates (2-16 per 100 deliveries) were observed internationally.
- Most countries showed increasing cesarean rates concurrent with decreasing operative vaginal delivery rates, though exceptions were noted.
- Cesarean section rates for multiple births and breech deliveries increased sharply in nearly all countries from 1980 to 1985.
- No significant association was found between 1985 national intervention rates and birth outcome measures.
Conclusions:
- National obstetric practices exhibit considerable heterogeneity, impacting intervention rates.
- Despite rising rates for specific cesarean indications, overall intervention levels did not correlate with improved birth outcomes in this ecological comparison.
- Achieving low early infant mortality is possible even with lower cesarean delivery rates, suggesting alternative factors are significant.