Comparative analysis of international cesarean delivery rates using 10-group classification identifies significant variation in spontaneous labor

• Published in: American journal of obstetrics and gynecology 2009-09, Vol.201 (3), p.308.e1-308.e8
• Main Authors: Brennan, Donal J., PhD, Robson, Michael S., MD, Murphy, Martina, RN, O'Herlihy, Colm, MD
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; cesarean section; Cesarean Section - classification; Cesarean Section - statistics & numerical data; Cesarean Section - trends; classification system; Delivery. Postpartum. Lactation; Female; Global Health; Gynecology. Andrology. Obstetrics; Humans; labor; Medical sciences; Obstetrics and Gynecology; Practice Patterns, Physicians' - statistics & numerical data; Pregnancy
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2009.06.021

Objective Cesarean section (CS) rates continue to rise throughout the developed world. The aim of this study was to highlight variations in obstetric populations and practices and to identify variations in CS rates in different institutions. Study Design Data from 9 institutional cohorts (total, 47,402; range, 1962-7985) from 9 different countries were examined using a 10-group classification system based on 4 characteristics of every pregnancy, namely single/multiple, nulliparity/multiparity, multiparity with CS scar, spontaneous/induced labor onset and term (≥37 weeks) gestation. Results Overall CS rates correlated with CS rates in singleton cephalic nullipara (r = 0.992; P < .001). Whereas CS rates in induced labor were similar, greatest institutional variation were seen in spontaneously laboring multiparas (6.7-fold difference) and nulliparas (3.7-fold difference). Conclusion Ten-group analysis of international obstetric cesarean practice identifies wide variations in women in spontaneous cephalic term labor, a low-risk cohort amenable to effective intrapartum corrective intervention.