Mauri Fabio, Schumacher Fanny, Weber Marta, Gayet-Ageron Angèle, Martinez de Tejada Begoña
Obstetrics Division, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.
Clinical Research Center, Geneva University Hospitals, Geneva, Switzerland.
Eur J Obstet Gynecol Reprod Biol X. 2023 Feb 21;17:100182. doi: 10.1016/j.eurox.2023.100182. eCollection 2023 Mar.
The caesarean section (CS) rate in Switzerland is currently 32 %, well above the WHO recommended rate of 15 %. The study aims were three-fold: to explore the perception of this high rate among Swiss obstetrics-gynecology (Ob-Gyn) professionals; to assess the factors associated with a perception of a too high national CS rate; and to describe professionals' opinions on measures to reduce this rate.
A cross-sectional study was conducted between 1 May and 30 June 2021 using an online questionnaire sent to Ob/Gyn physicians and midwives at a university hospital and members of the Swiss Conference of Heads of Ob/Gyn Divisions. Survey participation was voluntary. The main outcome was the belief that CS was high. Associations were explored between different factors and the main outcome with logistic regression. Results were presented as odds ratios (OR) with 95 % confidence intervals (CIs). Multivariate logistic regression included adjustments for age, gender, place of work and profession.
Of 226 health professionals invited, 188 completed the questionnaire (83.2 % participation rate). Among respondents, 50.3 % (n = 94) were Ob/Gyn physicians and 49.7 % were midwives (n = 93); 77.1 % were women (n = 145). Most participants (74.7 % [n = 139]) considered the Swiss CS rate as too high and that it should be reduced (79 % [n = 147]) but, notably, they considered their own CS rate as correct (71.9 % [n = 123]). Improving patient education (57.5 % [n = 108]) and professional training (54.8 % [n = 103]) were considered as strategies to reduce this rate. In multivariate analysis, only length of professional experience was significantly associated with a higher likelihood of considering the CS rate as too high (OR 3.07, 95 % CI 1.01-9.30; p = 0.047). When specialty was added in the model, the length of professional experience disappeared and the perception of having a too high CS rate was associated with being a midwife and obstetrician rather than a gynecologist (OR 3.62, 95 % CI 1.72-7.63; p = 0.001).
Clinicians, particularly obstetricians, believed that the current rate of CS in Switzerland was too high and that actions were needed to reduce this rate. Improving patient education and professional training were considered as the main strategies to be explored.
瑞士目前的剖宫产率为32%，远高于世界卫生组织建议的15%。本研究有三个目标：探讨瑞士妇产科专业人员对这一高剖宫产率的看法；评估与认为国家剖宫产率过高相关的因素；描述专业人员对降低该比率措施的意见。
2021年5月1日至6月30日进行了一项横断面研究，使用在线问卷向一家大学医院的妇产科医生和助产士以及瑞士妇产科部门负责人会议成员发放。调查参与是自愿的。主要结果是认为剖宫产率高。通过逻辑回归探讨不同因素与主要结果之间的关联。结果以比值比（OR）及95%置信区间（CI）呈现。多变量逻辑回归对年龄、性别、工作地点和职业进行了调整。
在226名受邀的卫生专业人员中，188人完成了问卷（参与率83.2%）。在受访者中，50.3%（n = 94）是妇产科医生，49.7%是助产士（n = 93）；77.1%是女性（n = 145）。大多数参与者（74.7% [n = 139]）认为瑞士的剖宫产率过高，应该降低（79% [n = 147]），但值得注意的是，他们认为自己的剖宫产率是正确的（71.9% [n = 123]）。改善患者教育（57.5% [n = 108]）和专业培训（54.8% [n = 103]）被认为是降低该比率的策略。在多变量分析中，只有专业经验时长与认为剖宫产率过高的可能性显著相关（OR 3.07，95% CI 1.01 - 9.30；p = 0.047）。当在模型中加入专业时，专业经验时长的影响消失，认为剖宫产率过高与身为助产士和产科医生而非妇科医生相关（OR 3.62，95% CI 1.72 - 7.63；p = 0.001）。
临床医生，尤其是产科医生，认为瑞士目前的剖宫产率过高，需要采取行动降低该比率。改善患者教育和专业培训被认为是需要探索的主要策略。
