Ueda Akihiko, Nakakita Baku, Chigusa Yoshitsugu, Mogami Haruta, Kato Genta, Ueshima Hiroaki, Mandai Masaki, Kondoh Eiji
Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan (Ueda, Nakakita, Chigusa, Mogami, Mandai, and Kondoh).
Solutions Center for Health Insurance Claims, Kyoto University Hospital, Kyoto, Japan (Kato).
AJOG Glob Rep. 2024 Jun 18;4(3):100366. doi: 10.1016/j.xagr.2024.100366. eCollection 2024 Aug.
The prevalence of cesarean section procedures is on the rise worldwide, necessitating a deeper understanding of the factors driving this trend to mitigate potential adverse consequences associated with unnecessary cesarean section deliveries.
This study aims to investigate the rate of primary cesarean deliveries (PCD), a potential key indicator of obstetric care quality.
A national retrospective cohort study was conducted utilizing extensive data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan spanning the years 2012 to 2018. The study examined the temporal trends in PCD rates and the indications for these procedures across different prefectures. Additionally, the study employed the obstetrician disproportionality index, as published by the Ministry of Health, Labour, and Welfare, to assess the influence of obstetrician availability on PCD rates.
Throughout the study period from 2012 to 2018, the rate of PCD in Japan remained relatively stable at approximately 14%. The primary indications for PCD in 2018 included labor arrest (18.3%), malpresentation (16.5%), nonreassuring fetal status (6.5%), and macrosomia (6.0%). Substantial regional disparities in PCD rates were observed, ranging from 8.9% to 20.4% among prefectures in 2018. Notably, prefectures categorized in the bottom 10 of the obstetrician disproportionality index exhibited significantly higher PCD rates compared to the top 10 prefectures (=.0232), with a similar trend noted for PCD due to labor arrest (=.0288). Furthermore, a negative correlation was identified between the obstetrician disproportionality index and PCD rates at the prefectural level (=-0.3119, =.0328).
Our study presents a comprehensive analysis of PCD rates in Japan, shedding light on regional disparities and highlighting the notable influence of obstetrician availability on clinical decision-making. This study contributes to the ongoing discourse on the escalating global trend in cesarean sections and the importance of healthcare resource allocation in maternal care.
剖宫产手术的全球患病率正在上升，因此有必要更深入地了解推动这一趋势的因素，以减轻与不必要的剖宫产分娩相关的潜在不良后果。
本研究旨在调查初次剖宫产分娩（PCD）率，这是产科护理质量的一个潜在关键指标。
利用日本国家健康保险索赔和特定健康检查数据库2012年至2018年的广泛数据进行了一项全国性回顾性队列研究。该研究调查了PCD率的时间趋势以及不同县这些手术的指征。此外，该研究采用了厚生劳动省公布的产科医生不均衡指数，以评估产科医生可及性对PCD率的影响。
在2012年至2018年的整个研究期间，日本的PCD率相对稳定，约为14%。2018年PCD的主要指征包括产程停滞（18.3%）、胎位异常（16.5%）、胎儿状况不良（6.5%）和巨大儿（6.0%）。观察到PCD率存在显著的地区差异，2018年各县的PCD率在8.9%至20.4%之间。值得注意的是，产科医生不均衡指数排名后10位的县的PCD率明显高于排名前10位的县（P =.0232），因产程停滞导致的PCD也有类似趋势（P =.0288）。此外，在县级层面，产科医生不均衡指数与PCD率之间存在负相关（r = -0.3119，P =.0328）。
我们的研究对日本的PCD率进行了全面分析，揭示了地区差异，并突出了产科医生可及性对临床决策的显著影响。本研究有助于持续讨论全球剖宫产率不断上升的趋势以及孕产妇护理中医疗资源分配的重要性。
