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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Article info
Publication history
Published online: January 28, 2020
Accepted:
October 3,
2019
Received:
August 1,
2019
Footnotes
Disclosures: This study was funded by the Canadian Institutes of Health Research (grant #PJT-148873). The funder did not have any role in the study design, data collection, data analysis, manuscript preparation, and/or publication decision. Dr. Metcalfe is supported by a New Investigator Award from the Canadian Institutes of Health Research (grant 360943).
The authors have indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
