Document Detail

Cesarean section delivery in the 1980s: international comparison by indication.
MedLine Citation:
PMID:  8116703     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: We compared trends and current levels of cesarean section delivery by indication in four countries to help us understand factors underlying national differences in obstetric delivery practice and identify pathways to lower cesarean rates. STUDY DESIGN: We carried out a measurement of change in the use of cesarean delivery by indication in Norway, Scotland, Sweden, and the United States during intervals centered on 1980, 1985, and 1990. Indication for cesarean delivery was determined by a standard set of selection rules. RESULTS: The rate of growth of national cesarean section rates dropped significantly between the time periods 1980 to 1985 and 1985 to 1990 in all four countries; in Sweden this led to an actual decline in the cesarean section rate. Fetal distress and previous cesarean section were important contributors to cesarean section growth in three of the countries in 1980 to 1985, but their contribution to growth dropped off sharply in 1985 to 1990. By the 1990 interval, the overall rate ranged from 24% (United States) to 11% (Sweden), and all four countries had similar cesarean section rates for breech presentation, fetal distress, and "other" indications. Cesarean section deliveries for previous cesarean section and dystocia accounted for the substantially higher U.S. cesarean section rate. CONCLUSIONS: Cesarean section rates are approaching stability in the four countries and have declined in Sweden. Previous cesarean delivery and dystocia may be the major sources of future reductions in the U.S. cesarean rate. The Swedish example shows that it is possible to reduce a relatively low national cesarean section rate.
F C Notzon; S Cnattingius; P Bergsjø; S Cole; S Taffel; L Irgens; A K Daltveit
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  170     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  1994 Feb 
Date Detail:
Created Date:  1994-03-30     Completed Date:  1994-03-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  495-504     Citation Subset:  AIM; IM    
National Center for Health Statistics, Centers for Disease Control, Hyattsville, MD 20782.
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MeSH Terms
Breech Presentation
Cesarean Section / statistics & numerical data,  trends*
Cesarean Section, Repeat / statistics & numerical data,  trends
Dystocia / surgery
Fetal Distress
United States

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