Carayol Marion, Blondel Béatrice, Zeitlin Jennifer, Breart Gérard, Goffinet François
INSERM, UMR S149, Epidemiological Research Unit on Perinatal Health and Women's Health, 123 Boulevard de Port Royal, Paris F-75014, France.
Eur J Obstet Gynecol Reprod Biol. 2007 May;132(1):20-6. doi: 10.1016/j.ejogrb.2006.05.017. Epub 2006 Jun 23.
To describe the changes in the rate of caesarean deliveries before labour among women with term breech presentations in France and to identify the factors associated with this change over two periods: 1972-1995/1998 and 1995/1998-2003.
The study population consisted of 1479 women with a foetus in a breech presentation at term and without any previous caesarean delivery, from the population of births in the 1972, 1995, 1998 and 2003 national perinatal surveys (N=53136). Data from the 1995 and 1998 surveys were pooled.
The principal endpoint was caesarean delivery before labour. Associations between the factors studied and caesarean before labour were estimated by odds ratios, both crude and adjusted with a logistic regression model.
Between 1972 and 2003, the rate of caesareans before labour for women with term breech presentations rose sharply (from 14.5% in 1972 to 42.6% in 1995/1998 and to 74.5% in 2003). Between 1972 and 1995/1998, this increase was especially marked among the nulliparous women (16.7% versus 52.9%). From 1995/1998 to 2003, the increase was greatest for multiparas: in 2003 this rate among women with children was close to that for women who had never given birth (64.5% and 79.5%, respectively). After adjustment, the factors associated with a high rate of caesarean before labour were nulliparity, birth between 38 and 40 weeks' gestation, birth weight > or =3800g, delivery in the private sector and year of delivery. The rate of caesareans before labour was significantly higher in 2003 (ORa=19.04 [12.06-30.06]) and in 1995-1998 (ORa=4.30 [2.87-6.47]) than in 1972.
The increase in the rate of caesarean deliveries before labour in women with term breech presentations was associated principally with changes in obstetrical practices.
描述法国足月臀位产妇临产前剖宫产率的变化情况，并确定1972 - 1995/1998年以及1995/1998 - 2003年这两个时间段内与该变化相关的因素。
研究人群包括1479名足月臀位胎儿且既往无剖宫产史的产妇，数据来自1972年、1995年、1998年和2003年全国围产期调查的出生人口（N = 53136）。1995年和1998年调查的数据合并使用。
主要终点是临产前剖宫产。通过比值比估计所研究因素与临产前剖宫产之间的关联，包括粗比值比和经逻辑回归模型调整后的比值比。
1972年至2003年期间，足月臀位产妇临产前剖宫产率急剧上升（从1972年的14.5%升至1995/1998年的42.6%，再到2003年的74.5%）。1972年至1995/1998年期间，初产妇中的上升尤为明显（从16.7%升至52.9%）。1995/1998年至2003年期间，经产妇的上升幅度最大：2003年，有子女的产妇这一比例接近从未生育过的产妇（分别为64.5%和79.5%）。调整后，与临产前剖宫产率高相关的因素包括初产、妊娠38至40周分娩、出生体重≥3800g、在私立部门分娩以及分娩年份。2003年（调整后比值比 = 19.04 [12.06 - 30.06]）和1995 - 1998年（调整后比值比 = 4.30 [2.87 - 6.47]）临产前剖宫产率显著高于1972年。
足月臀位产妇临产前剖宫产率的上升主要与产科实践的变化有关。
