Rana Tanvi, Satwah Syona, Bellussi Federica, Berghella Vincenzo
Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (Dr Rana and Ms Satwah).
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (Drs Bellussi and Berghella).
Am J Obstet Gynecol MFM. 2023 May;5(5):100839. doi: 10.1016/j.ajogmf.2022.100839. Epub 2022 Dec 20.
This study aimed to review obstetrical providers' personal preferences for cesarean delivery on maternal request in uncomplicated pregnancies.
Searches were performed in Ovid-Medline, Cochrane, Scopus, and CINAHL with terms related to "cesarean," "elective," "scheduled," "maternal request," "physician," "obstetrician," "gynecologist," "midwife," "specialist," and "trainee." There was no limitation placed on the language, year, or location of the studies included in the initial search strategy.
Articles were included if they focused on providers' personal preference for cesarean delivery on maternal request, if they were written in or translated into English, and if they did not meet any exclusion criteria.
The primary outcome was the percentage of providers preferring cesarean delivery on maternal request in a hypothetical uncomplicated nulliparous term singleton vertex pregnancy. The secondary outcomes included the percentage of providers preferring cesarean delivery on maternal request for a close family member in a nulliparous term singleton vertex pregnancy and the percentage of providers having a personal history of cesarean delivery on maternal request.
Overall, 34 articles were included in the review. The studies were conducted across a range of time and geographic locations. The main providers studied were obstetrician-gynecologists and midwives. In the hypothetical scenario asking their personal delivery preference for a nulliparous term singleton vertex pregnancy, the overall preference rate for cesarean delivery on maternal request among all obstetrical providers was 13.5% (966/7154), specifically 14.3% (894/6250) of obstetrician-gynecologists and 2% (11/574) of midwives; these percentages increased over the last 20 years. In the hypothetical scenario asking their delivery preference for a close family member in a nulliparous term singleton vertex pregnancy, these percentages changed to 28.5% (138/484), 67% (138/206), and 0% (0/278), respectively. The percentage of providers with a personal history of cesarean delivery on maternal request was 20.9% (486/2324) overall, specifically 25.2% (338/1339) of obstetrician-gynecologists and 2% (7/347) of midwives.
Overall, 14.3% of obstetrician-gynecologists would prefer cesarean delivery on maternal request for themselves in a hypothetical nulliparous term singleton vertex pregnancy, and this percentage has increased over the last 20 years. Moreover, 25.2% of obstetrician-gynecologists have had cesarean delivery on maternal request themselves, and 67% of obstetrician-gynecologists would recommend it for a close family member. Alternatively, ≤2% of midwives have had or would recommend cesarean delivery on maternal request.
本研究旨在回顾产科医护人员对于无并发症妊娠中因产妇要求而行剖宫产的个人偏好。
在Ovid-Medline、Cochrane、Scopus和CINAHL数据库中进行检索，检索词包括与“剖宫产”“择期”“计划”“产妇要求”“医生”“产科医生”“妇科医生”“助产士”“专家”和“实习生”相关的词汇。对初始检索策略纳入研究的语言、年份或地点均无限制。
若文章聚焦于医护人员对因产妇要求而行剖宫产的个人偏好，以英文撰写或翻译成英文，且未符合任何排除标准，则纳入研究。
主要结局为在假设的无并发症初产足月单胎头位妊娠中，倾向于因产妇要求而行剖宫产的医护人员的百分比。次要结局包括在无并发症初产足月单胎头位妊娠中，倾向于为近亲因产妇要求而行剖宫产的医护人员的百分比，以及有因产妇要求而行剖宫产个人史的医护人员的百分比。
总体而言，本综述纳入了34篇文章。这些研究在不同时间和地理位置开展。主要研究的医护人员为妇产科医生和助产士。在询问他们对无并发症初产足月单胎头位妊娠的个人分娩偏好的假设情景中，所有产科医护人员中因产妇要求而行剖宫产的总体偏好率为13.5%（966/7154），其中妇产科医生为14.3%（894/6250），助产士为2%（11/574）；这些百分比在过去20年中有所增加。在询问他们对无并发症初产足月单胎头位妊娠中近亲的分娩偏好的假设情景中，这些百分比分别变为28.5%（138/484）、67%（138/206）和0%（0/278）。有因产妇要求而行剖宫产个人史的医护人员的百分比总体为20.9%（486/2324），其中妇产科医生为25.2%（338/1339），助产士为2%（7/347）。
总体而言，在假设的无并发症初产足月单胎头位妊娠中，14.3%的妇产科医生倾向于因产妇要求为自己行剖宫产，且这一百分比在过去20年中有所增加。此外，25.2%的妇产科医生自己有因产妇要求而行剖宫产的经历，67%的妇产科医生会为近亲推荐因产妇要求而行剖宫产。相比之下，≤2%的助产士有过或会推荐因产妇要求而行剖宫产。
