Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Subiaco, Western Australia, Australia.
BMJ Open. 2013 May 2;3(5):e002789. doi: 10.1136/bmjopen-2013-002789.
The caesarean section rates have been rising in the developed world for over two decades. This study assessed the involvement of the public and private health sectors in this increase.
Population-based, retrospective cohort study.
Public and private hospitals in Western Australia.
Included in this study were 155 646 births to nulliparous women during 1996-2008.
Caesarean section rates were calculated separately for four patient type groups defined according to mothers' funding source at the time of birth (public/private) and type of delivery hospital (public/private). The average annual per cent change (AAPC) for the caesarean section rates was calculated using joinpoint regression.
Overall, there were 45 903 caesarean sections performed (29%) during the study period, 24 803 in-labour and 21 100 prelabour. Until 2005, the rate of caesarean deliveries increased most rapidly on average annually for private patients delivering in private hospitals (AAPC=6.5%) compared with public patients in public hospitals (AAPC=4.3%, p<0.0001). This increase could mostly be attributed to an increase in prelabour caesarean deliveries for this group of women and could not be explained by an increase in breech deliveries, placenta praevia or multiple pregnancies.
Our results indicate that an increase in the prelabour caesarean delivery rate for private patients in private hospitals has been driving the increase in the caesarean section rate for nulliparous women since 1996. Future research with more detailed information on indication for the prelabour caesarean section is needed to understand the reasons for these findings.
在发达国家，剖宫产率已经上升了二十多年。本研究评估了公共和私营卫生部门在这一增长中的参与情况。
基于人群的回顾性队列研究。
西澳大利亚州的公立和私立医院。
本研究纳入了 1996 年至 2008 年间 155646 名初产妇。
根据产妇分娩时的资金来源（公共/私人）和分娩医院类型（公共/私人），将剖宫产率分别计算为四个患者类型组。使用连接点回归计算剖宫产率的平均年百分比变化（AAPC）。
在研究期间，共有 45903 例剖宫产（29%），其中 24803 例为产时剖宫产，21100 例为产前剖宫产。直到 2005 年，与公立医院的公共患者相比，私立医院的私立患者剖宫产率的平均年增长率最快（AAPC=6.5%，p<0.0001）。这种增长主要归因于这组妇女产前剖宫产的增加，而不能用臀位分娩、前置胎盘或多胎妊娠的增加来解释。
我们的研究结果表明，自 1996 年以来，私立医院的私立患者产前剖宫产率的增加一直是初产妇剖宫产率上升的主要原因。未来需要进行更多关于产前剖宫产指征的详细信息研究，以了解这些发现的原因。
