Zimmo Mohammed, Laine Katariina, Hassan Sahar, Fosse Erik, Lieng Marit, Ali-Masri Hadil, Zimmo Kaled, Anti Marit, Bottcher Bettina, Sørum Falk Ragnhild, Vikanes Åse
Obstetrics Department, Al Shifa Hospital, Gaza, Palestine.
Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway.
BMJ Open. 2018 Mar 2;8(3):e019509. doi: 10.1136/bmjopen-2017-019509.
To assess the differences in rates and odds for emergency caesarean section among singleton pregnancies in six governmental Palestinian hospitals.
A prospective population-based birth cohort study.
Obstetric departments in six governmental Palestinian hospitals.
32 321 women scheduled to deliver vaginally from 1 March 2015 until 29 February 2016.
To assess differences in sociodemographic and antenatal obstetric characteristics by hospital, χ test, analysis of variance and Kruskal-Wallis test were applied. Logistic regression was used to estimate differences in odds for emergency caesarean section, and ORs with 95% CIs were assessed.
The primary outcome was the adjusted ORs of emergency caesarean section among singleton pregnancies for five Palestinian hospitals as compared with the reference (Hospital 1).
The prevalence of emergency caesarean section varied across hospitals, ranging from 5.8% to 22.6% among primiparous women and between 4.8% and 13.1% among parous women. Compared with the reference hospital, the ORs for emergency caesarean section were increased in all other hospitals, crude ORs ranging from 1.95 (95% CI 1.42 to 2.67) to 4.75 (95% CI 3.49 to 6.46) among primiparous women. For parous women, these differences were less pronounced, crude ORs ranging from 1.37 (95% CI 1.13 to 1.67) to 2.99 (95% CI 2.44 to 3.65). After adjustment for potential confounders, the ORs were reduced but still statistically significant, except for one hospital among parous women.
Substantial differences in odds for emergency caesarean section between the six Palestinian governmental hospitals were observed. These could not be explained by the studied sociodemographic or antenatal obstetric characteristics.
评估巴勒斯坦六家政府医院单胎妊娠紧急剖宫产的发生率及比值比差异。
一项基于人群的前瞻性出生队列研究。
巴勒斯坦六家政府医院的产科。
2015年3月1日至2016年2月29日计划经阴道分娩的32321名妇女。
通过χ检验、方差分析和Kruskal-Wallis检验评估不同医院间社会人口统计学和产前产科特征的差异。采用逻辑回归估计紧急剖宫产比值比的差异，并评估95%置信区间的比值比。
主要观察指标是与参照医院（医院1）相比，五家巴勒斯坦医院单胎妊娠紧急剖宫产的校正比值比。
各医院紧急剖宫产的患病率有所不同，初产妇中患病率在5.8%至22.6%之间，经产妇中患病率在4.8%至13.1%之间。与参照医院相比，其他所有医院紧急剖宫产的比值比均升高，初产妇的粗比值比在1.95（95%置信区间1.42至2.67）至4.75（95%置信区间3.49至6.46）之间。对于经产妇，这些差异不太明显，粗比值比在1.37（95%置信区间1.13至1.67）至2.99（95%置信区间2.44至3.65）之间。在对潜在混杂因素进行校正后，比值比有所降低，但仍具有统计学意义，经产妇中的一家医院除外。
观察到巴勒斯坦六家政府医院在紧急剖宫产比值比方面存在显著差异。这些差异无法用所研究的社会人口统计学或产前产科特征来解释。
