Korst Lisa M, Gornbein Jeffrey A, Gregory Kimberly D
Cedars-Sinai Medical Center Burns and Allen Research Institute, and the Department of Obstetrics and Gynecology, Women's Health Service Research, School of Medicine, University of California, Los Angeles, CA 90027, USA.
Med Care. 2005 Mar;43(3):237-45. doi: 10.1097/00005650-200503000-00006.
The cesarean rate has served an integral role in the monitoring of obstetrical care, and in 2002, the national rate reached 26.1%, the highest ever reported.
We sought to describe the effect of clinical complications on hospital cesarean rates.
This was a population-based cohort study.
All laboring women without a previous cesarean who delivered in California in 1995 as reported through public-use hospital discharge data were included.
Women with and without maternal, fetal, or placental complications were compared with respect to cesarean use. Using recursive partitioning algorithms, women with complications were stratified into clinically homogeneous categories, which were analyzed separately with respect to cesarean use.
The 443,532 women delivered at 288 hospitals and included 116,170 women (26.2%) in the complicated group (cesarean rate 22.6%); and 327,362 women (73.8%) in the uncomplicated group (cesarean rate 6.7%). At the hospital level, the cesarean rates among the complicated and uncomplicated patients respectively were: median 23.5% (range, 2.2-9.9%); and median 6.5% (range, 1.8-18.2%). Recursive partitioning algorithms suggested 16 distinct clinical categories, with cesarean rates varying from 8.9% for women with asthma to 84.5% for women with an unengaged fetal head.
Cesarean rates varied widely across complication types, and complication-specific rates varied widely among hospitals. Although the presence of pregnancy complications upon hospital admission comprised the strongest factor affecting first-time cesarean use among laboring women, the importance and interdependence of these clinical conditions has yet to be incorporated into commonly used models for cesarean rate comparisons.
剖宫产率在产科护理监测中发挥着不可或缺的作用，2002年，全国剖宫产率达到26.1%，为有记录以来的最高值。
我们试图描述临床并发症对医院剖宫产率的影响。
这是一项基于人群的队列研究。
纳入所有1995年在加利福尼亚州分娩、此前未做过剖宫产且通过公开的医院出院数据报告的产妇。
比较有和没有母体、胎儿或胎盘并发症的产妇的剖宫产情况。使用递归划分算法，将有并发症的产妇分层为临床特征相同的类别，并分别分析其剖宫产情况。
443,532名产妇在288家医院分娩，其中116,170名产妇（26.2%）属于并发症组（剖宫产率22.6%）；327,362名产妇（73.8%）属于无并发症组（剖宫产率6.7%）。在医院层面，并发症组和无并发症组患者的剖宫产率分别为：中位数23.5%（范围2.2 - 9.9%）；中位数6.5%（范围1.8 - 18.2%）。递归划分算法显示有16种不同的临床类别，剖宫产率从哮喘产妇的8.9%到胎头未衔接产妇的84.5%不等。
不同并发症类型的剖宫产率差异很大，且特定并发症的剖宫产率在不同医院间也有很大差异。尽管入院时存在妊娠并发症是影响产妇首次剖宫产的最主要因素，但这些临床情况的重要性和相互依存关系尚未纳入常用的剖宫产率比较模型中。
