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Survey of Mode of Delivery and Maternal and Perinatal Outcomes in Canada

      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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