Birth outcomes following cesarean delivery on maternal request: a population-based cohort study

被引：19

作者：

Guo, Yanfang ^{[1
,2
,3
]}

Murphy, Malia S. Q. ^{[2
]}

Erwin, Erica ^{[1
,2
]}

Fakhraei, Romina ^{[2
,3
]}

Corsi, Daniel J. ^{[1
,2
,3
]}

White, Ruth Rennicks ^{[2
,4
]}

Harvey, Alysha L. J. ^{[2
]}

Gaudet, Laura M. ^{[5
,6
]}

Walker, Mark C. ^{[1
,2
,4
]}

Wen, Shi Wu ^{[2
,4
]}

El-Chaar, Darine ^{[2
,4
]}

机构：

[1] Ottawa Hosp Res Inst, Better Outcomes Registry Network Ontario, Clin Epidemiol Program, Ottawa, ON, Canada

[2] Ottawa Hosp Res Inst, OMNI Res Grp, Clin Epidemiol Program, Ottawa, ON, Canada

[3] Childrens Hosp, Eastern Ontario Res Inst, Ottawa, ON, Canada

[4] Ottawa Hosp, Dept Obstet Gynecol & Newborn Care, Ottawa, ON, Canada

[5] Kingston Hlth Sci Ctr, Dept Obstet & Gynecol, Kingston, ON, Canada

[6] Queens Univ, Dept Obstet & Gynecol, Kingston, ON, Canada

来源：

CANADIAN MEDICAL ASSOCIATION JOURNAL | 2021年 / 193卷 / 18期

基金：

加拿大健康研究院;

关键词：

VAGINAL DELIVERY; SECTION; OBSTETRICIANS; WOMEN; RISK; EPIDEMIOLOGY; MORBIDITY; MORTALITY; ACCURACY; DISORDER;

D O I：

10.1503/cmaj.202262

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: Data on the effect of cesarean delivery on maternal request (CDMR) on maternal and neonatal outcomes are inconsistent and often limited by inadequate case definitions and other methodological issues. Our objective was to evaluate the trends, determinants and outcomes of CDMR using an intent-to-treat approach. METHODS: We designed a population-based retrospective cohort study using data on low-risk pregnancies in Ontario, Canada (April 2012-March 2018). We assessed temporal trends and determinants of CDMR. We estimated the relative risks for component and composite outcomes used in the Adverse Outcome Index (AOI) related to planned CDMR compared with planned vaginal delivery using generalized estimating equation models. We compared the Weighted Adverse Outcome Score (WAOS) and the Severity Index (SI) across planned modes of delivery using analysis of variance. RESULTS: Of 422 210 women, 0.4% (n = 1827) had a planned CDMR and 99.6% (n = 420 383) had a planned vaginal delivery. The prevalence of CDMR remained stable over time at 3.9% of all cesarean deliveries. Factors associated with CDMR included late maternal age, higher education, conception via in vitro fertilization, anxiety, nulliparity, being White, delivery at a hospital providing higher levels of maternal care and obstetrician-based antenatal care. Women who planned CDMR had a lower risk of adverse outcomes than women who planned vaginal delivery (adjusted relative risk 0.42, 95% confidence interval [CI] 0.33 to 0.53). The WAOS was lower for planned CDMR than planned vaginal delivery (mean difference -1.28, 95% CI -2.02 to -0.55). The SI was not statistically different between groups (mean difference 3.6, 95% CI -7.4 to 14.5). Interpretation: Rates of CDMR have not increased in Ontario. Planned CDMR is associated with a decreased risk of short-term adverse outcomes compared with planned vaginal delivery. Investigation into the long-term implications of CDMR is warranted.

引用

页码：E634 / E644

页数：11

共 52 条

[1] No. 361-Caesarean Delivery on Maternal Request [J].