J Zhang1, C Geerts2, C Hukkelhoven3, P Offerhaus4, J Zwart5, A de Jonge2. 1. MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 2. Midwifery Science, AVAG/EMGO, VU University Medical Centre, Amsterdam, the Netherlands. 3. The Netherlands Perinatal Registry, Utrecht, the Netherlands. 4. KNOV, the Royal Dutch Midwifery Organisation, Utrecht, the Netherlands. 5. Department of Obstetrics and Gynaecology, Deventer Ziekenhuis, Deventer, the Netherlands.
Abstract
OBJECTIVES: To identify factors that are associated with a relatively low caesarean section (CS) rate by examining the CS rate in various subgroups in the Netherlands. DESIGN: Cross-sectional analysis. SETTINGS: the Netherlands. POPULATION: A total of 685 452 births in the Netherlands Perinatal Registry from 2007 to 2010. METHODS: A modified classification system for CS was used to categorise all women into ten groups. Labour management, mode of delivery, maternal and neonatal morbidity and mortality were assessed according to these ten groups. MAIN OUTCOME MEASURES: Caesarean section, labour induction, instrumental delivery, postpartum haemorrhage, perineal laceration, duration of second stage of labour, Apgar score, fetal and neonatal mortality. RESULTS: Total CS rate was 15.6%. Term, nulliparous and parous women with a singleton pregnancy of a fetus in cephalic position and spontaneous onset of labour had CS rates of 9.6 and 1.9% and instrumental birth rates of 19.4 and 2.4%, respectively; 17.3% of births were induced. Among women with a previous CS and term, singleton pregnancies with a fetus in cephalic presentation, 71% had trial of labour, of which 75% had a successful vaginal birth. Of women with multiple gestation, 43% had CS. Women with CS due to 'failure to progress' in the second stage of labour had a median duration of second-stage pushing of almost 2 hours in nulliparas and >90 minutes in parous women. CONCLUSIONS: Several obstetric practice patterns may have contributed to the relatively low overall CS rate in the Netherlands: a relatively low CS rate in term, singleton pregnancies of a fetus in cephalic position and spontaneous onset of labour, relatively low rate of labour induction, a high rate of a trial of labour after a previous CS, the use of vacuum and forceps, and a high proportion of women being taken care of by midwives. TWEETABLE ABSTRACT: The Netherlands has several practice patterns that may have contributed to its relatively low CS rate.
OBJECTIVES: To identify factors that are associated with a relatively low caesarean section (CS) rate by examining the CS rate in various subgroups in the Netherlands. DESIGN: Cross-sectional analysis. SETTINGS: the Netherlands. POPULATION: A total of 685 452 births in the Netherlands Perinatal Registry from 2007 to 2010. METHODS: A modified classification system for CS was used to categorise all women into ten groups. Labour management, mode of delivery, maternal and neonatal morbidity and mortality were assessed according to these ten groups. MAIN OUTCOME MEASURES: Caesarean section, labour induction, instrumental delivery, postpartum haemorrhage, perineal laceration, duration of second stage of labour, Apgar score, fetal and neonatal mortality. RESULTS: Total CS rate was 15.6%. Term, nulliparous and parous women with a singleton pregnancy of a fetus in cephalic position and spontaneous onset of labour had CS rates of 9.6 and 1.9% and instrumental birth rates of 19.4 and 2.4%, respectively; 17.3% of births were induced. Among women with a previous CS and term, singleton pregnancies with a fetus in cephalic presentation, 71% had trial of labour, of which 75% had a successful vaginal birth. Of women with multiple gestation, 43% had CS. Women with CS due to 'failure to progress' in the second stage of labour had a median duration of second-stage pushing of almost 2 hours in nulliparas and >90 minutes in parous women. CONCLUSIONS: Several obstetric practice patterns may have contributed to the relatively low overall CS rate in the Netherlands: a relatively low CS rate in term, singleton pregnancies of a fetus in cephalic position and spontaneous onset of labour, relatively low rate of labour induction, a high rate of a trial of labour after a previous CS, the use of vacuum and forceps, and a high proportion of women being taken care of by midwives. TWEETABLE ABSTRACT: The Netherlands has several practice patterns that may have contributed to its relatively low CS rate.
Authors: Y Zhang; A P Betran; X Li; D Liu; N Yuan; L Shang; W Lin; S Tu; L Wang; X Wu; T Zhu; Y Zhang; Z Lu; L Zheng; C Gu; J Fang; Z Liu; L Ma; Z Cai; X Yang; H Li; H Zhang; X Zhao; L Yan; L Wang; X Sun; Q Luo; L Liu; J Zhu; W Qin; Q Yao; S Dong; Y Yang; Z Cui; Y He; X Feng; L He; H Zhang; L Zhang; X Wang; J P Souza; H Qi; T Duan; J Zhang Journal: BJOG Date: 2021-10-26 Impact factor: 7.331
Authors: Marcos Nakamura-Pereira; Maria do Carmo Leal; Ana Paula Esteves-Pereira; Rosa Maria Soares Madeira Domingues; Jacqueline Alves Torres; Marcos Augusto Bastos Dias; Maria Elisabeth Moreira Journal: Reprod Health Date: 2016-10-17 Impact factor: 3.223
Authors: A E Seijmonsbergen-Schermers; D C Zondag; M Nieuwenhuijze; T Van den Akker; C J Verhoeven; C Geerts; F Schellevis; A De Jonge Journal: BMC Pregnancy Childbirth Date: 2018-06-01 Impact factor: 3.007
Authors: Jin-Wen Zhang; Ware Branch; Matthew Hoffman; Ank De Jonge; Sheng-Hui Li; James Troendle; Jun Zhang Journal: BMJ Open Date: 2018-08-05 Impact factor: 2.692