Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York.
Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware.
JAMA Netw Open. 2023 Mar 1;6(3):e235428. doi: 10.1001/jamanetworkopen.2023.5428.
Reducing rates of unnecessary cesarean deliveries is both a national and a global health objective. However, there are limited national US data on trends in indications for low-risk cesarean delivery.
To determine temporal trends in and indications for cesarean delivery among patients at low risk for the procedure over a 20-year period.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed 2000 to 2019 delivery hospitalizations using the National Inpatient Sample. Births at low risk for cesarean delivery were identified using a definition from the Society for Maternal-Fetal Medicine and additional criteria. Temporal trends in cesarean birth were analyzed using joinpoint regression to estimate the average annual percentage change (AAPC) with 95% CIs. Data analysis was performed from August 2022 to January 2023.
This analysis evaluated cesarean birth trends in a population at low risk for this procedure over a 20-year period.
In addition to overall cesarean birth risk, cesarean deliveries for nonreassuring fetal status and labor arrest were individually analyzed.
Of an estimated 76.7 million delivery hospitalizations, 21.5 million were excluded according to the Society for Maternal-Fetal Medicine definition, and 14.7 million were excluded according to additional criteria. Of the estimated 40 517 867 deliveries included, 12.1% (4 885 716 deliveries) were by cesarean delivery. Cesarean deliveries among patients at low risk for the procedure increased from 9.7% to 13.9% between 2000 and 2009, plateaued, and then decreased from 13.0% to 11.1% between 2012 and 2019. The AAPC for cesarean delivery was 6.4% (95% CI, 5.2% to 7.6%) from 2000 to 2005, 1.2% from 2005 to 2009 (95% CI, -1.2% to 3.7%), and -2.2% from 2009 to 2019 (95% CI, -2.7% to -1.8%). Cesarean delivery for nonreassuring fetal status increased from 3.4% of all deliveries in 2000 to 5.1% in 2019 (AAPC, 2.1%; 95% CI, 1.7% to 2.5%). Cesarean delivery for labor arrest increased from 3.6% in 2000 to a peak of 4.8% in 2009 before decreasing to 2.7% in 2019. Cesarean deliveries for labor arrest increased during the first half of the study (2000-2009) for the active phase (from 1.5% to 2.1%), latent phase (from 1.1% to 1.5%), and second stage (from 0.9% to 1.3%) and then decreased from 2010 to 2019, from 2.1% to 1.7% for the active phase, from 1.5% to 1.2% for the latent phase, and from 1.2% to 0.9% for the second stage.
Cesarean deliveries among patients at low risk for cesarean birth appeared to decrease over the latter years of the study period, with cesarean deliveries for labor arrest becoming less common.
降低不必要的剖宫产率既是国家也是全球的健康目标。然而，美国关于低风险剖宫产指征的全国性数据有限。
在 20 年的时间里，确定低危剖宫产患者的剖宫产率及其指征的时间趋势。
设计、地点和参与者：本横断面研究使用国家住院患者样本分析了 2000 年至 2019 年的分娩住院情况。使用来自母胎医学学会的定义和其他标准来确定低危剖宫产的分娩。使用 joinpoint 回归分析剖宫产分娩的时间趋势，以估计具有 95%置信区间的平均年百分比变化 (AAPC)。数据分析于 2022 年 8 月至 2023 年 1 月进行。
这项分析评估了 20 年来低危剖宫产人群的剖宫产分娩趋势。
除了总体剖宫产风险外，还单独分析了非胎儿状况不良和产程阻滞的剖宫产指征。
在估计的 7670 万分娩住院患者中，根据母胎医学学会的定义排除了 2150 万，根据其他标准排除了 1470 万。在估计的 4051.7867 次分娩中，有 12.1%（4885716 次分娩）为剖宫产。2000 年至 2009 年间，低危剖宫产患者的剖宫产率从 9.7%上升至 13.9%，之后趋于平稳，然后在 2012 年至 2019 年间从 13.0%下降至 11.1%。2000 年至 2005 年剖宫产率的 AAPC 为 6.4%（95%CI，5.2%至 7.6%），2005 年至 2009 年为 1.2%（95%CI，-1.2%至 3.7%），2009 年至 2019 年为-2.2%（95%CI，-2.7%至-1.8%）。非胎儿状况不良的剖宫产率从 2000 年所有分娩的 3.4%上升至 2019 年的 5.1%（AAPC，2.1%；95%CI，1.7%至 2.5%）。产程阻滞的剖宫产率从 2000 年的 3.6%上升至 2009 年的峰值 4.8%，然后在 2019 年降至 2.7%。产程阻滞的剖宫产率在研究的前半段（2000-2009 年）增加，活跃期（从 1.5%增加到 2.1%）、潜伏期（从 1.1%增加到 1.5%）和第二产程（从 0.9%增加到 1.3%），然后从 2010 年到 2019 年减少，活跃期从 2.1%减少到 1.7%，潜伏期从 1.5%减少到 1.2%，第二产程从 1.2%减少到 0.9%。
在研究后期，低危剖宫产患者的剖宫产率似乎有所下降，产程阻滞的剖宫产率也有所下降。
