Why Women With Previous Caesarean and Eligible for a Trial of Labour Have an Elective Repeat Caesarean Delivery? A National Study in France
| Autor: | François Goffinet, Béatrice Blondel, Catherine Deneux-Tharaux, S. Bartolo |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
medicine.medical_specialty Pediatrics medicine.medical_treatment Caesarean delivery Population Body Mass Index 03 medical and health sciences 0302 clinical medicine Pregnancy medicine Humans Caesarean section 030212 general & internal medicine Cesarean Section Repeat education education.field_of_study 030219 obstetrics & reproductive medicine Cesarean Section Obstetrics business.industry Trial of labour Obstetrics and Gynecology Odds ratio medicine.disease Vaginal Birth after Cesarean Trial of Labor Pregnancy Complications Cross-Sectional Studies Elective Surgical Procedures National study Female France business Body mass index |
| Zdroj: | Obstetric Anesthesia Digest. 37:74-75 |
| ISSN: | 0275-665X |
| Popis: | Objective To identify the characteristics of women and maternity units associated with elective repeat caesarean delivery (ERCD) in women eligible for trial of labour after caesarean (TOLAC). Design Cross-sectional study. Setting France. Population and sample Using data from the 2010 French National Perinatal Survey, a representative sample of births in France (n = 14 681 women), we studied two groups of women with prior caesarean section: (i) women eligible for TOLAC according to guidelines (n = 1179) and (ii) a subgroup of these women without any medical characteristics that might indicate ERCD (n = 575). Methods Associations were analysed by multilevel logistic regression. Main outcome measures Adjusted odds ratios. Results Among the 1584 women with a previous caesarean, 1179 (74.4%) were eligible for TOLAC according to guidelines (group 1); 490 (41.6%) had ERCD. Risk of ERCD increased with increasing maternal age and body mass index, pre-existing condition and suspected macrosomia and decreased with previous vaginal deliveries. Among the unit characteristics, private status (aOR = 2.3, 95% CI 1.3–4.1) and low level of care (aOR = 2.5, 95% CI 1.4–4.5]) were independently associated with a higher risk of ERCD after adjustment on patient/pregnancy characteristics. The variability of ERCD rate between hospitals was mainly (78%) explained by the status and level of care, and not (0%) by patient/pregnancy characteristics. Associations with unit characteristics were similar for group 2. Conclusion For women eligible for TOLAC, the rate of ERCD is high and not in agreement with guidelines. Some characteristics of women are associated with ERCD, but the main determinants are at the unit level, which suggests that non-medical reasons are involved in the decision process. Tweetable abstract Elective repeat caesarean in women eligible for trial of labour mainly depends on maternity unit characteristics. |
| Databáze: | OpenAIRE |
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