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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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    The Obstetrician & Gynaecologist 10/2011; 13(4).
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    ABSTRACT: To review maternal mortality in a large stand-alone maternity hospital in a European city and to determine whether the increased cesarean rate was associated with an increase in maternal deaths. The details of maternal deaths at Coombe Women and Infants University Hospital, Dublin, Ireland, as published in the hospital's Annual Clinical Reports for 1995-2009, were reviewed. Maternal mortality ratio was defined as the number of maternal deaths per 100,000 live births. Over 15 years, 112,326 women delivered 114 170 infants weighing at least 500 g. The cesarean rate increased from 14.1% in 1995 to 26.5% in 2009 (20.0% overall). The maternal mortality ratio was low at 2.7 per 100 000 live births. There were 2 maternal deaths following cesarean, neither of which was attributable to the operation. In Ireland, a large stand-alone maternity hospital can achieve a low maternal mortality ratio, according to international standards, despite an increase in cesarean rate over the past 2 decades. There was no evidence that the increased cesarean rate had an adverse impact on maternal mortality ratio.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 11/2011; 116(2):162-4. · 1.41 Impact Factor
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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. 01/2014;

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