Brennan Donal J, Robson Michael S, Murphy Martina, O'Herlihy Colm
National Maternity Hospital, Dublin, Ireland.
Am J Obstet Gynecol. 2009 Sep;201(3):308.e1-8. doi: 10.1016/j.ajog.2009.06.021.
Cesarean section (CS) rates continue to rise throughout the developed world. The aim of this study was to highlight variations in obstetric populations and practices and to identify variations in CS rates in different institutions.
Data from 9 institutional cohorts (total, 47,402; range, 1962-7985) from 9 different countries were examined using a 10-group classification system based on 4 characteristics of every pregnancy, namely single/multiple, nulliparity/multiparity, multiparity with CS scar, spontaneous/induced labor onset and term (>or=37 weeks) gestation.
Overall CS rates correlated with CS rates in singleton cephalic nullipara (r = 0.992; P < .001). Whereas CS rates in induced labor were similar, greatest institutional variation were seen in spontaneously laboring multiparas (6.7-fold difference) and nulliparas (3.7-fold difference).
Ten-group analysis of international obstetric cesarean practice identifies wide variations in women in spontaneous cephalic term labor, a low-risk cohort amenable to effective intrapartum corrective intervention.
剖宫产率在整个发达国家持续上升。本研究旨在突出产科人群和实践的差异，并确定不同机构剖宫产率的差异。
使用基于每次妊娠的4个特征（即单胎/多胎、初产/经产、有剖宫产瘢痕的经产、自然发动/引产分娩以及足月（≥37周）妊娠）的10组分类系统，对来自9个不同国家的9个机构队列（总数47402例；范围1962 - 7985例）的数据进行了分析。
总体剖宫产率与单胎头位初产妇的剖宫产率相关（r = 0.992；P <.001）。引产时的剖宫产率相似，但自然分娩经产妇（相差6.7倍）和初产妇（相差3.7倍）的机构差异最大。
对国际产科剖宫产实践的十组分析表明，自然头位足月分娩的女性存在很大差异，这是一个低风险队列，适合有效的产时纠正干预。
