Cesarean birth in the United States: epidemiology, trends, and outcomes.

Reproductive Statistics Branch, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Room 7318, Hyattsville, MD 20782, USA.
Clinics in Perinatology (Impact Factor: 2.58). 07/2008; 35(2):293-307, v. DOI: 10.1016/j.clp.2008.03.007
Source: PubMed

ABSTRACT The percentage of United States cesarean births increased from 20.7% in 1996 to 31.1% in 2006. Cesarean rates increased for women of all ages, race/ethnic groups, and gestational ages and in all states. Both primary and repeat cesareans have increased. Increases in primary cesareans in cases of "no indicated risk" have been more rapid than in the overall population and seem the result of changes in obstetric practice rather than changes in the medical risk profile or increases in "maternal request." Several studies note an increased risk for neonatal and maternal mortality for medically elective cesareans compared with vaginal births.

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    ABSTRACT: Objective To evaluate the effectiveness of an intervention to adjust the indications for caesarean delivery in a Brazilian teaching hospital in accordance with a specific protocol. Methods The present before-and-after study was carried out in three stages. In stages 1 and 3, data were obtained for 160 cesarean deliveries that occurred between May 20 and July 10 in 2011 and 2012, respectively. For stage 2, the protocol was implemented for 12 months. The deliveries in stages 1 and 3 were classified as high or low risk, and as consistent or inconsistent clinical cases on the basis of the protocol. Results A total of 160 (61.1%; 95% confidence interval [CI] 55.2–67.0) of 262 deliveries in stage 1 were by cesarean, compared with 160 (71.4%; 95% CI 65.5–77.3) of 224 in stage 3 (P = 0.67). In stage 1, 125 (78.1%; 95% CI 71.7–84.5) showed indications consistent with the protocol, compared with 136 (85.0%; 95% CI 79.5–90.5) in stage 3 (P = 0.11). Among the low-risk cesarean deliveries, 27 (51.9%; 95% CI 38.3–65.5) of 52 were consistent with the protocol in stage 1, compared with 49 (72.1%; 95% CI 61.4–86.1) of 68 in stage 3 (P = 0.02). Conclusion The proposed intervention improved the suitability of indications for cesarean delivery among low-risk pregnancies only.
    International Journal of Gynecology & Obstetrics. 10/2014;
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    The Obstetrician & Gynaecologist 10/2011; 13(4).
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    ABSTRACT: Background During the postpartum period, women are vulnerable to depression affecting about 10 to 20% of mothers during the first year after delivery. However, only 50% of women with prominent symptoms are diagnosed with postpartum depression (PPD). The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening instrument for PPD . The main objectives of this study are to assess whether an EPDS score of 9 or more on day 2 (D2) postpartum is predictive of a depressive episode between days 30 and 40 postpartum (D30-40), to determine the risk factors as well as the prevalence of PPD in a sample of Lebanese women and to determine a threshold score of EPDS predictive of PPD.MethodsA sample of 228 women were administered the EPDS on D2. An assessment for PPD was done on D30-40 during a telephone interview.ResultsOn D2, the average score on EPDS was 7.1 (SD¿=¿5.2) and 33.3% of women had an EPDS score¿¿¿9. On D30-40 postpartum, the average score was 6.5 (SD¿=¿4.7) and 19 women (12.8%) presented with PPD. A positive correlation was shown between scores on EPDS on D2 and D30-40 (r¿=¿0.5091, p¿<¿0.0001). A stepwise regression shows that an EPDS score ¿9 on D2 (p¿<¿0.001) and a personal history of depression (p¿=¿0.008) are significantly associated with the diagnosis of PPD on D30-40.Conclusion The EPDS may be considered as a reliable screening tool on as early as D2 after delivery. Women with EPDS score¿¿¿9 and/or a positive personal history of major depressive disorder should benefit from a closer follow-up during the rest of the post-partum period.
    BMC Psychiatry 09/2014; 14(1):242. · 2.23 Impact Factor


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