Abstract
Objective
To identify determinants of cesarean delivery (CD) and examine associations between
mode of delivery (MOD) and maternal and perinatal outcomes.
Methods
We conducted a retrospective analysis of a Canadian multicentre birth cohort derived
from provincial data collected in 2008/2009. Maternal and perinatal characteristics
and outcomes were compared between vaginal and cesarean birth and between the following
MOD subgroups: spontaneous vaginal delivery (VD), assisted VD, planned cesarean delivery
(CD), and intrapartum CD. Multivariate regression identified determinants of CD and
the effects of MOD and previous CD on maternal and perinatal outcomes.
Results
The cohort included 264 755 births (72.1% VD and 27.9% CD) from 91 participating institutions.
Determinants of CD included maternal age, parity, previous CD, chronic hypertension,
diabetes, urinary tract infection or pyelonephritis, gestational hypertension, vaginal
bleeding, labour induction, pre-term gestational age, low birth weight, large for
gestational age, malpresentation, and male sex. CD was associated with greater risk
of maternal and perinatal morbidity and mortality. Subgroup analysis demonstrated
higher risk of adverse pregnancy outcomes with assisted VD and intrapartum CD than
spontaneous VD. Planned CD reduced the risk of obstetric wound hematoma and perinatal
mortality but increased maternal and neonatal morbidity. Previous CD increased the
risk of maternal and neonatal morbidity among multiparous women.
Conclusions
The CD rate in Canada is consistent with global trends reflecting demographic and
obstetric intervention factors. The risk of adverse pregnancy outcomes with CD warrants
evaluation of interventions to safely prevent nonessential cesarean birth.
Résumé
Objectif
Définir les déterminants de la césarienne et examiner les associations entre le mode
d’accouchement et les issues maternelles et périnatales.
Méthodologie
Nous avons effectué une analyse rétrospective d’une cohorte canadienne multicentrique
d’accouchements à partir de données provinciales recueillies pour la période 2008-2009.
Les caractéristiques et issues maternelles et périnatales ont été comparées entre
l’accouchement vaginal et la césarienne et entre les sous-groupes des modes d’accouchement
: accouchement vaginal (AV) spontané, AV assisté, césarienne planifiée et césarienne
per partum. Une régression multivariée a permis de définir les déterminants de la
césarienne et les effets du mode d’accouchement et des antécédents de césarienne sur
les issues maternelles et périnatales.
Résultats
La cohorte compte 264 755 accouchements (72,1 % d’AV et 27,9 % de césariennes) ayant
eu lieu dans 91 établissements participants. Les déterminants de la césarienne étaient
: âge maternel, parité, antécédents de césarienne, hypertension chronique, diabète,
infection urinaire ou pyélonéphrite, hypertension gestationnelle, saignements vaginaux,
déclenchement artificiel du travail, âge gestationnel prématuré, faible poids à la
naissance, hypertrophie fœtale, présentation anormale et sexe masculin. La césarienne
a été associée à une augmentation du risque de morbidité et mortalité maternelles
et périnatales. L’analyse en sous-groupes a permis de constater une augmentation du
risque d’issues de grossesse défavorables en cas d’AV assisté et de césarienne per
partum par comparaison à l’AV spontané. La césarienne planifiée a réduit le risque
d’hématome de plaie obstétricale et de mortalité périnatale, mais a augmenté le risque
de morbidité maternelle ou néonatale. Les antécédents de césarienne ont augmenté le
risque de morbidité maternelle ou néonatale chez les femmes multipares.
Conclusions
Le taux de césariennes au Canada est comparable aux tendances mondiales et reflète
les facteurs démographiques et d’interventions obstétricales. Le risque d’issues de
grossesse défavorables en cas de césarienne justifie l’évaluation d’interventions visant
à prévenir la césarienne non essentielle en toute sécurité.
Keywords
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References
- The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014.PLoS One. 2016; 11e0148343
- Childbirth indicators by place of residence: 2001-2002 to 2018-2019.(Available at:)https://www.cihi.ca/en/dadhmdb-childbirth-indicators-by-place-of-residenceDate accessed: January 4, 2022
- WHO statement on caesarean section rates.BJOG. 2016; 123: 667-670
- Relationship between cesarean delivery rate and maternal and neonatal mortality.JAMA. 2015; 314: 2263-2270
- Changes in maternal characteristics and obstetric practice and recent increases in primary cesarean delivery.Obstet Gynecol. 2003; 102: 791-800
- Contribution of prepregnancy body mass index and gestational weight gain to caesarean birth in canada.BMC Pregnancy Childbirth. 2014; 14: 106
- No. 361-caesarean delivery on maternal request.J Obstet Gynaecol Can. 2018; 40: 967-971
- Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group.Lancet. 2000; 356: 1375-1383
- No. 381-assisted vaginal birth.J Obstet Gynaecol Can. 2019; 41: 870-882
- Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America.Lancet. 2006; 367: 1819-1829
- Short-term and long-term effects of caesarean section on the health of women and children.Lancet. 2018; 392: 1349-1357
- Mode of delivery and problems in subsequent births: a register-based study from finland.Am J Obstet Gynecol. 2005; 193: 169-177
- Methodological considerations in implementing the WHO global survey for monitoring maternal and perinatal health.Bull World Health Organ. 2008; 86: 126-131
- Cesarean delivery outcomes from the WHO global survey on maternal and perinatal health in africa.Int J Gynaecol Obstet. 2009; 107: 191-197
- Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08.Lancet. 2010; 375: 490-499
- Global epidemiology of use of and disparities in caesarean sections.Lancet. 2018; 392: 1341-1348
- Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys.Lancet Glob Health. 2015; 3: e260-e270
- No. 382-trial of labour after caesarean.J Obstet Gynaecol Can. 2019; 41: 992-1011
- The attitudes of Canadian maternity care practitioners towards labour and birth: many differences but important similarities.J Obstet Gynaecol Can. 2009; 31: 827-840
- FIGO position paper: how to stop the caesarean section epidemic.Lancet. 2018; 392: 1286-1287
- Preventable obstetrical interventions: how many caesarean sections can be prevented in Canada?.J Obstet Gynaecol Can. 2013; 35: 434-443
- Recent trends in caesarean delivery rates and indications for caesarean delivery in Canada.J Obstet Gynaecol Can. 2004; 26: 735-742
- Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term.CMAJ. 2007; 176: 455-460
- Severe maternal morbidity and the mode of delivery.Acta Obstetricia et Gynecologica. 2008; 87: 662-668
- Pregnancy outcomes of women with previous caesarean sections: secondary analysis of World Health Organization Multicountry Survey on Maternal and Newborn Health.Sci Rep. 2019; 9: 9748
- Safe prevention of the primary cesarean delivery.Am J Obstet Gynecol. 2014; 210: 179-193
- Interventions to reduce unnecessary caesarean sections in healthy women and babies.Lancet. 2018; 392: 1358-1368
- A cluster-randomized trial to reduce cesarean delivery rates in Quebec.N Engl J Med. 2015; 372: 1710-1721
Article info
Publication history
Published online: May 17, 2022
Accepted:
April 22,
2022
Received:
February 12,
2022
Footnotes
Disclosures: Funding for this study was provided by a Canadian Institutes of Health Research Operating Grant of CAN $500 000. Organizational support for the Canadian Mode of Delivery Study Group was provided by the Maternal-infant Care Research Centre at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by a Canadian Institutes of Health Research Team Grant (CTP 87518) and Mount Sinai Hospital. The study sponsors had no role in the study design; the collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the paper for publication. All authors confirm they had full access to all data in the study and accept responsibility to submit for publication.
All authors have indicated they meet the journal’s requirements for authorship.
Identification
Copyright
© 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
