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Potential Impact of Guidelines for the Prevention of Cesarean Deliveries in a Contemporary Canadian Population

Published:January 28, 2020DOI:https://doi.org/10.1016/j.jogc.2019.10.010

      Abstract

      Objective

      This study sought to describe how the implementation of recent labour guidelines may affect the cesarean delivery rate in a population in Alberta.

      Methods

      This retrospective study was conducted on primiparous women who were in labour with singleton term fetuses with cephalic presentation in Alberta from 2007 to 2016 (n = 181 738), and it used data from a perinatal database. Modelled cesarean delivery rates were calculated to determine the potential impact of the recent guidelines on the cesarean delivery rate by using the percentage of cesarean deliveries that occurred outside the threshold of the recent labour guidelines.

      Results

      A total of 21.7% of the cesarean deliveries for dystocia occurred outside of the guidelines related to the first stage of labour arrest for spontaneous labour (n = 9282), and 45.4% occurred outside of the guidelines related to the first stage of labour arrest for induced labours (n = 11 712). A total of 69.0% of the cesarean deliveries for dystocia occurred outside of the failed induction of labour guidelines (n = 4921), and 55.4% occurred outside of the second stage labour arrest guidelines (n = 6632). Assuming that the labour arrest guidelines are effective at reducing the cesarean delivery rate 25% of the time, the cesarean delivery rate for primiparous women in labour would be reduced from 22.5% to 20.7%. Assuming a 75% adherence/effectiveness rate, the cesarean delivery rate would be reduced to 17.1%.

      Conclusion

      The recent labour guidelines have the potential to have a substantial impact on the intrapartum cesarean delivery rate in primiparous women with singleton fetuses with cephalic presentation at term if the guidelines are put into practice.

      Résumé

      Objectif

      Cette étude cherchait à décrire la façon dont les récentes directives relatives au travail peuvent influer sur le taux de césariennes au sein d'une population en Alberta.

      Méthodologie

      Cette étude rétrospective a été menée en Alberta de 2007 à 2016 chez des femmes primipares en travail en cas de grossesse monofœtale à terme avec présentation céphalique (n = 181 738); elle s'appuie également sur des données tirées d'une base de données périnatales. Les taux de césariennes modélisés ont été calculés pour déterminer l'incidence potentielle des récentes directives relatives au travail sur le taux de césariennes en utilisant le pourcentage de césariennes qui ont eu lieu à l'extérieur des limites définies dans ces directives.

      Résultats

      Au total, 21,7 % des césariennes pratiquées pour cause de dystocie ont eu lieu en marge des directives relatives à l'arrêt du travail au premier stade en cas de travail spontané (n = 9 282) et 45,4 % ont eu lieu en marge des limites des directives relatives à l'arrêt du travail au premier stade en cas de déclenchement artificiel (n = 11 712). Au total, 69,0 % des césariennes pratiquées pour cause de dystocie ont eu lieu en marge des directives relatives à l'échec du déclenchement artificiel (n = 4 921) et 55,4 % ont eu lieu en marge des limites des directives relatives à l'arrêt du travail au deuxième stade (n = 6 632). Si l'on présume que les directives relatives à l'arrêt du travail sont efficaces pour réduire le taux de césariennes dans 25 % des cas, le taux de césariennes chez les femmes primipares en travail devrait passer de 22,5 % à 20,7 %. Selon un taux d'adhésion et d'efficacité de 75 %, le taux de césariennes diminuerait pour passer à 17,1 %.

      Conclusion

      Les récentes directives relatives au travail ont un important potentiel d'incidence sur le taux de césariennes intrapartum chez les femmes primipares en cas de grossesse monofœtale à terme avec présentation céphalique si les directives sont mises en pratique.

      Keywords

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