Potential avoidability of planned cesarean sections in a French national database

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Epidemiology

Background:

• Cesarean sections are a common surgical procedure with increasing rates globally.
• Understanding the factors contributing to potentially avoidable cesareans is crucial for optimizing maternal and infant outcomes.
• National guidelines exist for classifying cesarean sections, but their application in identifying avoidable procedures requires further study.

Purpose of the Study:

• To determine the frequency of potentially avoidable planned cesarean sections in France.
• To identify the key indications, maternal obstetric history, and current pregnancy factors associated with potentially avoidable planned cesareans.
• To inform targeted interventions aimed at reducing unnecessary cesarean delivery rates.

Main Methods:

• A cross-sectional, population-based study utilizing data from the 2010 French National Perinatal Survey.
• Inclusion of 14,681 women from 535 maternity units across France.
• Classification of planned cesareans into avoidable and unavoidable categories based on French national guidelines and medical record data, with logistic regression analyses performed separately for primiparas and multiparas.

Main Results:

• The overall planned cesarean rate was 10.9%, with 28% identified as potentially avoidable.
• Breech presentation and a history of one previous cesarean were the primary reasons for 83% of avoidable planned cesareans.
• Maternal age over 35, intensive pregnancy surveillance, and private hospital status were significant determinants of potentially avoidable cesareans, particularly in primiparas and multiparas. Obesity was a determinant only in multiparas.

Conclusions:

• A substantial proportion of planned cesarean sections are potentially avoidable, highlighting specific obstetric situations and patient characteristics.
• The findings provide valuable insights for developing targeted public health policies and clinical guidelines to reduce the overall cesarean section rate.
• Further research and implementation strategies are needed to translate these findings into practice and improve obstetric care quality.