Department of Gynaecology and Obstetrics, Gynépole, Assistance Publique-Hôpitaux de Marseille, AMU, Aix- Marseille Université, Marseille, France.
EA 3279 -Public Health, chronic diseases and quality of life-Research Unit, Aix-Marseille University, Marseille, France.
PLoS One. 2018 Aug 27;13(8):e0202475. doi: 10.1371/journal.pone.0202475. eCollection 2018.
To assess the factors associated with lower rate of caesarean deliveries in the South of France, based on the characteristics and organisation of the region's 40 maternity facilities and the characteristics of the practitioners in these facilities.
A retrospective study from 1 January 2012 to 31 December 2015. Data were collected by the Mediterranean network and a declarative survey was completed by each maternity facility in the region to study factor which could be associated with lower caesarean rate by univariate and multivariate analysis.
250 564 women gave birth during this period, of which 55 097 by caesarean section. The mean caesarean delivery rate over the four years was 22.0%. The rate was significantly higher in private maternity facilities [23.9% (21.9%- 25.8%), p<0.05] and type III (maximum care level) maternity facilities [24.2% (21.3%- 27.1%), p<0.05]. After a stepwise regression, the factors associated with a decrease in the caesarean delivery rate were audits concerning caesarean delivery (19.83%, β = - 2.48, p = 0.03 over the four years) and the provision of training to trainee doctors at the maternity facility (20.28%, β = - 1.08, p = 0.04 over the four years).
Performing audits in relation to caesarean deliveries could affect the caesarean. Teaching trainee doctors could be an indicator of quality of caesarean practices. They should be encouraged in maternity facilities to reduce the rate of caesareans.
根据法国南部 40 家产科医疗机构的特点和组织以及这些医疗机构从业者的特点，评估与剖宫产率较低相关的因素。
这是一项回顾性研究，时间为 2012 年 1 月 1 日至 2015 年 12 月 31 日。数据由地中海网络收集，该地区的每个产科医疗机构都完成了一份申报调查，以研究可能通过单因素和多因素分析与较低剖宫产率相关的因素。
在此期间，有 250564 名妇女分娩，其中 55097 名经剖宫产分娩。四年间平均剖宫产率为 22.0%。私立产科医疗机构（23.9%（21.9%-25.8%），p<0.05）和三级（最高护理水平）产科医疗机构（24.2%（21.3%-27.1%），p<0.05）的剖宫产率显著较高。经过逐步回归分析，与剖宫产率下降相关的因素包括剖宫产审计（4 年间为 19.83%，β=-2.48，p=0.03）和在产科医疗机构为实习医生提供培训（4 年间为 20.28%，β=-1.08，p=0.04）。
开展剖宫产审计可能会影响剖宫产率。在产科医疗机构教授实习医生可能是剖宫产实践质量的指标。应鼓励在产科医疗机构中减少剖宫产率。
