Giani Umberto, Bruzzese Dario, Pugliese Aniello, Saporito Maurizio, Triassi Maria
Dipartimento di scienze mediche preventive, Università degli studi di Napoli Federico II, Italy.
Epidemiol Prev. 2011 Mar-Apr;35(2):101-10.
to assess both clinical and non clinical factors associated with elective caesarean section practice and to highlight those typologies of expectant mothers who underwent elective caesarean delivery even in the absence of clinical risk factors.
Birth Certificates archive has been used as data source: 62888 available records of all the births that occurred in the Campania region in 2005 both in public and private hospitals. Only those births pertained to women without previous caesarean sections were analyzed.
type of delivery, dichotomized as elective caesarean section and vaginal delivery.
after adjusting the data for known risk factors, elective caesarean section practice emerged as much more prevalent in private hospitals than in public ones (53.1% vs 24.3%, p<0.001). A multivariate logistic regression model showed a significant association between primiparity and elective caesarean section. This association was stronger in private hospitals (OR for interaction between parity and hospital typology 1.81, CI 95% 1.62-2.04). Being older than 34 years, having recoursed to medically assisted procreation and a previous voluntary termination of pregnancy cause an increase in the odd of resorting to elective caesarean section (p<0.01). Being foreigner, high educational qualification and young age were protective factors for elective caesarean section (respectively, OR 0.36 CI 95% 0.31-0.42, OR 0.81 CI 95% 0.77-0.86 e OR 0.84 CI 95% 0.78 -0.90). Five different typologies of primiparous women were found by means of a hierarchical classification procedure. A high percentage of elective caesarean section was found in women assisted in private structure with no clinical risk.
in Campania there is an excess of elective caesarean sections among primiparous women without manifest clinical risk factors; this excess is higher when the delivery occurs in Private Hospitals. Public health policy and actions aimed at reducing caesarean section rates should be addressed mainly to this typology of women.
评估与择期剖宫产相关的临床和非临床因素，并突出那些即使在没有临床风险因素的情况下也接受择期剖宫产的孕妇类型。
出生证明档案被用作数据源：2005年坎帕尼亚地区公立和私立医院所有出生记录的62888条可用记录。仅分析那些属于无既往剖宫产史女性的分娩情况。
分娩类型，分为择期剖宫产和阴道分娩。
在对已知风险因素的数据进行调整后，择期剖宫产在私立医院的发生率远高于公立医院（53.1%对24.3%，p<0.001）。多因素逻辑回归模型显示初产与择期剖宫产之间存在显著关联。这种关联在私立医院更强（产次与医院类型之间的交互作用的OR为1.81，95%CI为1.62 - 2.04）。年龄大于34岁、采用辅助生殖技术以及既往有自愿终止妊娠史会增加择期剖宫产的几率（p<0.01）。外籍、高学历和年轻是择期剖宫产的保护因素（分别为OR 0.36，95%CI为0.31 - 0.42；OR 0.81，95%CI为0.77 - 0.86；OR 0.84，95%CI为0.78 - 0.90）。通过分层分类程序发现了五种不同类型的初产妇。在无临床风险且在私立机构接受辅助的女性中，择期剖宫产的比例很高。
在坎帕尼亚，无明显临床风险因素的初产妇中择期剖宫产过多；当分娩发生在私立医院时，这种过多情况更为严重。旨在降低剖宫产率的公共卫生政策和行动应主要针对这类女性。
