Potential Impact of Guidelines for the Prevention of Cesarean Deliveries in a Contemporary Canadian Population |
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| Affiliation: | 1. Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB;2. Department of Community Health Sciences, University of Calgary, Calgary, AB;3. Department of Medicine, University of Calgary, Calgary, AB;1. Health Quality Ontario, Toronto, ON;2. Laboratory Medicine and Genetics Program, Trillium Health Partners, Mississauga, ON;3. Program of Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, ON;4. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON;5. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON;6. Department of Family and Community Medicine, Sinai Health System, University of Toronto, Toronto, ON;7. Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON;8. Prenatal Screening Ontario, Better Outcomes Registry and Network (BORN) Ontario, Ottawa, ON;9. Genetics Program, North York General Hospital, Toronto, ON;10. Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Québec City, QC;1. Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON;2. Department of Radiology, University of Ottawa, Ottawa, ON;3. Ottawa-Carleton Institute of Biomedical Engineering, Ottawa, ON;4. Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON;1. Department of Obstetrics and Gynecology, Brigham and Women''s Hospital, Boston, MA;2. Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA;3. Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA |
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| Abstract: | ObjectiveThis study sought to describe how the implementation of recent labour guidelines may affect the cesarean delivery rate in a population in Alberta.MethodsThis 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.ResultsA 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%.ConclusionThe 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. |
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