Achieving more with less: lessons from country-level analyses of caesarean delivery and perinatal outcomes in Europe
| العنوان: | Achieving more with less: lessons from country-level analyses of caesarean delivery and perinatal outcomes in Europe |
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| المؤلفون: | J Zeitlin, L Mortensen, JG Nijhuis, A Recio Alcaide, P Velebil, V Tica, E Mierzejewska, K Klungsoyr, S Donati, A Macfarlane |
| المصدر: | European Journal of Public Health. 32 |
| بيانات النشر: | Oxford University Press (OUP), 2022. |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | Public Health, Environmental and Occupational Health |
| الوصف: | Background There is consensus that caesarean delivery (CD) is a lifesaving procedure for both mother and child in emergency situations and that CD without medical indication should be avoided. However, the rate that optimally balances the risks and benefits of CD is unresolved. In 1985, the World Health Organization concluded that the CD rate should be no more than 10-15%; subsequent reviews relating CD rates to infant mortality show no benefits at the country-level for rates higher than 15-19%. However, stillbirth has not been investigated because comparable international stillbirth data are not readily available. Methods We conducted an ecological study in 25 European countries from 2015 to 2019 utilizing data from routine birth data sources aggregated using the Euro-Peristat PHIRI federated data analysis protocol. We assessed country-level associations between CD rates and perinatal outcomes (singleton preterm birth, stillbirth at ≤ 24 weeks’ gestational age, neonatal death) for all years using Pearson correlations, adjusted for clustering of years within country. Correlations were also estimated between linear trends over time in the indicators. Results The median [range] of CD rates was 23.1% [16.2 to 56.9] in 21 participating countries, while these were 6.9% [5.3 to 11.9] for preterm birth, 3.3 per 1000 total births [1.8 to 7.6] for stillbirth and 1.9 per 1000 live births [0.7 to 6.1] for neonatal mortality. The CD rate was not associated with the stillbirth rate (cluster-adjusted rho: -.01, P=.94) or with the neonatal mortality rate (rho:.27, P=.27). However, there was a strong positive correlation with the preterm birth rate (rho:.81, P Conclusions Higher CD rates were not associated with lower stillbirth or neonatal mortality rates, but were strongly correlated with higher preterm birth rates. This study suggests no benefits and indicates potential harms for higher CD rates in Europe. |
| تدمد: | 1464-360X 1101-1262 |
| DOI: | 10.1093/eurpub/ckac129.112 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_________::3f87d7becd50aa53d4be3eebccfcdd81 https://doi.org/10.1093/eurpub/ckac129.112 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi...........3f87d7becd50aa53d4be3eebccfcdd81 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 1464360X 11011262 |
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| DOI: | 10.1093/eurpub/ckac129.112 |