Notzon F C, Cnattingius S, Bergsjø P, Cole S, Taffel S, Irgens L, Daltveit A K
National Center for Health Statistics, Centers for Disease Control, Hyattsville, MD 20782.
Am J Obstet Gynecol. 1994 Feb;170(2):495-504. doi: 10.1016/s0002-9378(94)70217-9.
We compared trends and current levels of cesarean section delivery by indication in four countries to help us understand factors underlying national differences in obstetric delivery practice and identify pathways to lower cesarean rates.
We carried out a measurement of change in the use of cesarean delivery by indication in Norway, Scotland, Sweden, and the United States during intervals centered on 1980, 1985, and 1990. Indication for cesarean delivery was determined by a standard set of selection rules.
The rate of growth of national cesarean section rates dropped significantly between the time periods 1980 to 1985 and 1985 to 1990 in all four countries; in Sweden this led to an actual decline in the cesarean section rate. Fetal distress and previous cesarean section were important contributors to cesarean section growth in three of the countries in 1980 to 1985, but their contribution to growth dropped off sharply in 1985 to 1990. By the 1990 interval, the overall rate ranged from 24% (United States) to 11% (Sweden), and all four countries had similar cesarean section rates for breech presentation, fetal distress, and "other" indications. Cesarean section deliveries for previous cesarean section and dystocia accounted for the substantially higher U.S. cesarean section rate.
Cesarean section rates are approaching stability in the four countries and have declined in Sweden. Previous cesarean delivery and dystocia may be the major sources of future reductions in the U.S. cesarean rate. The Swedish example shows that it is possible to reduce a relatively low national cesarean section rate.
我们比较了四个国家剖宫产指征的趋势和当前水平，以帮助我们了解各国产科分娩实践存在差异的潜在因素，并确定降低剖宫产率的途径。
我们对挪威、苏格兰、瑞典和美国在以1980年、1985年和1990年为中心的时间段内剖宫产指征的使用变化进行了测量。剖宫产指征由一套标准的选择规则确定。
在所有四个国家中，1980年至1985年期间与1985年至1990年期间相比，国家剖宫产率的增长率显著下降；在瑞典，这导致剖宫产率实际下降。胎儿窘迫和既往剖宫产是1980年至1985年期间三个国家剖宫产率增长的重要因素，但在1985年至1990年期间，它们对增长的贡献急剧下降。到1990年这个时间段，总体剖宫产率从24%（美国）到11%（瑞典）不等，并且所有四个国家在臀位、胎儿窘迫和“其他”指征方面的剖宫产率相似。因既往剖宫产和难产进行的剖宫产导致美国剖宫产率显著更高。
四个国家的剖宫产率正在接近稳定，并且在瑞典已经下降。既往剖宫产和难产可能是未来美国剖宫产率降低的主要来源。瑞典的例子表明，降低一个相对较低的国家剖宫产率是可能的。
