Inselspital, Bern University Hospital, SWITZERLAND;
Swiss Med Wkly. 2014 Feb 19;144:w13921. doi: 10.4414/smw.2014.13921.
Caesarean section (CS) rates have risen over the past two decades. The aim of this observational study was to identify time-dependent variations in CS and vaginal delivery rates over a period of 11 years.
All deliveries (13,701 deliveries during the period 1999-2009) at the University Women's Hospital Bern were analysed using an internationally standardised and approved ten-group classification system. Caesarean sections on maternal request (CSMR) were evaluated separately.
We detected an overall CS rate of 36.63% and an increase in the CS rate over time (p <0.001). Low-risk profile groups were the two largest populations and displayed low CS rates, with significantly decreasing relative size over time. The relative size of groups with induced labour increased significantly, but this did not have an impact on the overall CS rate. Pregnancies complicated by breech position, multiple pregnancies and abnormal lies did not have an impact on overall CS rate. The biggest contributor to a high CS rate was preterm delivery and the existence of a uterine scar from a previous CS. CSMR was 1.45% and did not have an impact on the overall CS rate.
The observational study identified wide variations in caesarean section and vaginal delivery rates across the groups over time, and a shift towards high-risk populations was noted. The biggest contributors to high CS rates were identified; namely, previous uterine scar and preterm delivery. Interventions aiming to reduce CS rates are planned.
在过去的二十年中，剖宫产率有所上升。本观察性研究旨在确定 11 年间剖宫产率和阴道分娩率的时间依赖性变化。
使用国际标准化和批准的十组分类系统分析伯尔尼大学妇女医院的所有分娩（1999-2009 年期间的 13701 次分娩）。单独评估因产妇要求行剖宫产术（CSMR）。
我们发现剖宫产率总体为 36.63%，且剖宫产率随时间增加（p<0.001）。低风险组是两个最大的人群，剖宫产率较低，相对大小随时间呈显著下降趋势。因诱导分娩而使人群比例显著增加，但这并未对总体剖宫产率产生影响。臀位、多胎妊娠和异常胎位妊娠并未对总体剖宫产率产生影响。导致高剖宫产率的最大因素是早产和先前剖宫产形成的子宫瘢痕。CSMR 为 1.45%，对总体剖宫产率没有影响。
本观察性研究发现，随着时间的推移，各分组的剖宫产率和阴道分娩率存在广泛差异，高危人群的比例有所增加。确定了导致高剖宫产率的主要因素，即先前的子宫瘢痕和早产。计划实施旨在降低剖宫产率的干预措施。
