Signorelli C, Cattaruzza M S, Osborn J F
Institute of Hygiene, School of Medicine, University La Sapienza, Rome, Italy.
Public Health. 1995 May;109(3):191-9. doi: 10.1016/s0033-3506(05)80052-6.
A recent large increase in Caesarean section (CS) in Italy was the initial stimulus for a study to identify risk factors for CS and, if possible, to suggest strategies to counteract the rise. The study was conducted in three hospitals where a wide range of individual variables was collected from the clinical records and from personal interviews. Crude CS rates and odds ratios were evaluated for each single variable while logistic regression has been used to investigate possible confounding factors. The study involved 1316 consecutive deliveries. Crude CS rates were 29.4%, 15.7% and 16.1%. Variables identified as high risk factors were pre-eclampsia, previous CS, breech and other non-vertex presentations. Antenatal care under an obstetrician working in the same hospital, a low number of antenatal consultations, previous miscarriages, offer (by obstetrician) and request (by women) for CS showed significantly high odds ratios (ORs). Previous live births was strongly negatively associated with CS. No relationship between type of delivery and social status was observed while a physician factor was detected in all three hospitals where rates for different physicians ranged from 0% to 52.8%. Apart from the main medical indications for Caesarean section (previous CS, breech presentation), the results seem to indicate that individual practice style may be an important determinant of the wide variation in the rates of Caesarean delivery. While this may have been suspected before this study, these results are the first hard data to indicate that, in Italy, CS is widely performed for non-medical reasons.
近期意大利剖宫产率大幅上升，这是开展一项研究的最初动因，该研究旨在确定剖宫产的风险因素，并在可能的情况下提出应对剖宫产率上升的策略。这项研究在三家医院进行，从临床记录和个人访谈中收集了广泛的个体变量。对每个单一变量评估了粗剖宫产率和比值比，同时使用逻辑回归来调查可能的混杂因素。该研究涉及1316例连续分娩。粗剖宫产率分别为29.4%、15.7%和16.1%。被确定为高风险因素的变量有子痫前期、既往剖宫产史、臀位及其他非头位胎位。由同一家医院的产科医生进行产前护理、产前检查次数少、既往流产史、产科医生提议（剖宫产）及产妇要求（剖宫产）的比值比显著较高。既往活产与剖宫产呈强烈负相关。未观察到分娩方式与社会地位之间的关系，而在所有三家医院均检测到医生因素，不同医生的剖宫产率在0%至52.8%之间。除了剖宫产的主要医学指征（既往剖宫产史、臀位）外，结果似乎表明个体医疗行为方式可能是剖宫产率广泛差异的一个重要决定因素。虽然在本研究之前可能就有人怀疑这一点，但这些结果是首批确凿数据，表明在意大利，剖宫产广泛用于非医学原因。
