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PubMed2006

Is there a useful cesarean birth measure? Assessment of the nulliparous term singleton vertex cesarean birth rate as a tool for obstetric quality improvement.

OBJECTIVE: This study was undertaken to assess the utility of the nulliparous term singleton vertex cesarean birth (NTSV CB) measure as a quality improvement tool for use at the hospital level. STUDY DESIGN: We prospectively collected data on all NTSV births in Sutter Health's 20 birthing units over a 3-year period, 2001 through 2003, totaling 41,416 births. Hospital rates of NTSV CB, obstetric practices, and infant outcomes were calculated and compared by using weighted logistic analyses. In addition, we examined the effect of maternal age on the NTSV CB measure by using direct standardization with US norms for nulliparous women. RESULTS: There was large variation noted in the NTSV CB rate among the 20 hospitals, with unadjusted rates ranging from 10.5% to 30.2%. Strong correlations were found between CB rates and labor induction rates (r = 0.57, P < .0001) and with early labor admission rates (r = 0.62, P < .0001). The strongest correlation was found between NTSV CB rates and a combined measure of induction and early labor admission (r = 0.73, P < .0001). Rates of term 5-minute Apgar score below 7 were not correlated with the NTSV CB rate. Hospital nulliparous maternal age distribution varied markedly and direct standardization led to significant changes in the NTSV CB rate. CONCLUSION: NTSV CB rate is strongly influenced by elective obstetric practices. The addition of an easily performed maternal age adjustment makes it the most promising CB quality measure for use at the hospital level.

Birth Rate↗
PubMed1983

[Premature birth rate, incidence of cesarean section and perinatal mortality between 1945 and 1980. An analysis of 55,000 births].

56,686 single births between 1945 and 1980 were evaluated in a retrospective study. The results reflect the change which has taken place in obstetrics. Perinatal mortality dropped in a straight line from 48.50/00 to 17.20/00. At the same time, the frequency of Caesarian section increased in non-linear progression from an initial value of 1.9% (1945-1949) to 14.0% (1975-1980). The rate of early births dropped in the first ten years only from 10.6% to 7.3%, followed by an approximately constant value up to 1969. From 1970 onwards, there is a rising tendency (6.7% to 7.7%) which was found in all weight categories. The share of early births in perinatal mortality dropped during the first years only, from 77% to 63%, and has since remained constant. If we compare the periods 1945 to 1959 and 1970 to 1980 with regard to indications for Caesarian section, assuming a birth weight of more than 2500 g, the indication of cessation of labour would rise from the 4th rank to the 1st position, whereas disproportion and asphyxia of the newborn continue to occupy the 2nd and 4th ranks, respectively, despite a relative increase. Meanwhile, the indication "condition after Caesarian section" now occupies the 3rd rank. In newborn weighing less than 2500 g, the prominent indications are early birth, asphyxia, desire to have a child and breech presentation, whereas emergency indications were previously the most important ones.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗