Di Giovanni Pamela, Garzarella Tonia, Di Martino Giuseppe, Schioppa Francesco Saverio, Romano Ferdinando, Staniscia Tommaso
Department of Pharmacy, "G. d'Annunzio" University of Chieti-Pescara, via dei Vestini, 31 -, 66100, Chieti, Italy.
Postgraduate School of Public Health and Preventive Medicine, "G. d'Annunzio" University of Chieti-Pescara, via dei Vestini, 31 -, 66100, Chieti, Italy.
BMC Health Serv Res. 2018 Jul 3;18(1):514. doi: 10.1186/s12913-018-3332-2.
Primary caesarean section (PCS) rate is one of the main indicators of quality of care suggested by the Italian Government. Hospital rankings are usually based on it, therefore lower rates reflect more appropriate clinical practice. The aim of this study is to describe a five-year trend of PCS rate in Abruzzo region from 2009 to 2013 and to examine the medical indications for this mode of delivery.
Forty-five thousand one hundred forty-nine deliveries occurring from 2009 to 2013 were collected from all hospital discharge records (HDR) and analyzed. Among them we found 12,542 PCS. Odds ratios (ORs) with 95% confidence interval (95% CI) were estimated using logistic regression methods to evaluate the relationship between maternal risk factors and PCS in hospital over 1000 delivery/yrs.
The five-year PCS rate was 28.9%, with a decreasing trend from 31.4% in 2009 to 26.1% in 2013. Vasto Civil Hospital shows the lowest PCS rate (17.9% in 2013) among hospitals with a maximum of 1000 deliveries per year, while Pescara Civil Hospital shows the lowest PCS rate (25.4% in 2013) among hospitals with over 1000 deliveries per year. Women with major risk factors for cesarean section delivered more frequently in maternity units over 1000 delivery/yrs. Logistic regression analyses showed as diabetes, hypertension, twin pregnancy, fetal distress and preterm delivery were significant risk factors to deliver in unit over 1000 delivery/yrs. The most frequent (overall 66.6%) discharge diagnosis recorded in Hospital discharge records (HDR) is "Caesarean Delivery Without Indication". 7.3% of PCS made in Abruzzo concerns women living in other Italian regions. 11.4% of PCS contains one of the indications to caesarean section (CS) that the Italian Guidelines consider appropriate.
During the analyzed period, Abruzzo showed a decreasing, but still too high, PCS rate, compared to the limits fixed by the Italian Ministry of Health. Considering the limitation of this study, based on administrative data that are poor in clinical information, it is not possible to define the appropriateness of all caesarean sections.
剖宫产率是意大利政府建议的医疗质量主要指标之一。医院排名通常基于此，因此较低的剖宫产率反映了更恰当的临床实践。本研究的目的是描述2009年至2013年阿布鲁佐地区剖宫产率的五年趋势，并探讨这种分娩方式的医学指征。
收集了2009年至2013年所有医院出院记录中的45149例分娩情况并进行分析。其中我们发现了12542例剖宫产。使用逻辑回归方法估计比值比（OR）及95%置信区间（95%CI），以评估每年分娩超过1000例的医院中孕产妇风险因素与剖宫产之间的关系。
五年剖宫产率为28.9%，呈下降趋势，从2009年的31.4%降至2013年的26.1%。在每年最多分娩1000例的医院中，瓦斯托市立医院的剖宫产率最低（2013年为17.9%），而佩斯卡拉市立医院在每年分娩超过1000例的医院中剖宫产率最低（2013年为25.4%）。有剖宫产主要风险因素的女性在每年分娩超过1000例的产科单位分娩更为频繁。逻辑回归分析显示，糖尿病、高血压、双胎妊娠、胎儿窘迫和早产是在每年分娩超过1000例的单位分娩的显著风险因素。医院出院记录（HDR）中记录的最常见（总体为66.6%）出院诊断是“无指征剖宫产”。阿布鲁佐地区进行的剖宫产中有7.3%涉及居住在意大利其他地区的女性。11.4%的剖宫产包含意大利指南认为合适的剖宫产指征之一。
在分析期间，与意大利卫生部设定的限制相比，阿布鲁佐地区的剖宫产率呈下降趋势，但仍然过高。考虑到本研究的局限性，基于临床信息匮乏的行政数据，无法确定所有剖宫产的适宜性。
