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Intervention thresholds and cesarean section rates: A time-trends analysis.

Anna Rose1, Edwin Amalraj Raja2, Sohinee Bhattacharya3

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Acta Obstetricia Et Gynecologica Scandinavica
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Summary

Rising cesarean section (CS) rates in the UK are linked to lower clinical thresholds for intrapartum procedures. While CS rates increased, birth trauma for newborns decreased, suggesting a trade-off in obstetric interventions.

Keywords:
cesareanclinical thresholdintrapartum

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Public Health

Background:

  • Cesarean section (CS) rates have been rising globally, prompting investigations into contributing factors.
  • Understanding the influence of clinical decision-making on CS rates is crucial for optimizing maternal and neonatal outcomes.

Purpose of the Study:

  • To investigate the relationship between clinician thresholds for performing cesarean sections (CS) for delayed labor progress or suspected fetal distress and the actual CS rates.
  • To analyze trends in CS rates and associated clinical practices in Aberdeen, UK, from 1988 to 2012.

Main Methods:

  • A time-trends analysis was conducted on term births of nulliparous women (N=53,745) in Aberdeen, UK, between 1988 and 2012.
  • Statistical methods included Chi-square test for trend and binary logistic regression, utilizing data from the Aberdeen Maternity and Neonatal Databank.

Main Results:

  • Unplanned CS rates increased from 11.0% to 21.1%, and planned CS rates rose from 2.7% to 5.2% during the study period.
  • The median duration of labor before CS for delayed progress decreased significantly (P < .001).
  • CS for suspected fetal distress with evidence of fetal acidosis declined (P < .01), while neonatal unit admission was higher after unplanned CS (aOR 1.99). Birth trauma was less likely following CS (aORs 0.48-0.33).

Conclusions:

  • Lowered clinical thresholds for intrapartum cesarean sections contribute to the observed increase in CS rates.
  • Higher CS rates were associated with a reduction in birth trauma for newborns, indicating a complex interplay of risks and benefits.