Cesarean section and the manipulation of exact delivery time

Fabbri, Daniele; Monfardini, Chiara; Castaldini, Ilaria; Protonotari, Adalgisa

doi:10.1016/j.healthpol.2016.05.001

Cited by 9 publications

(12 citation statements)

References 33 publications

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“…In a study from Spain, an increase in cesarean delivery during early night hours between 11pm and 4am was observed and was associated with poor perinatal outcomes. 10 In an Italian study, 11 semi-urgent cesarean deliveries overnight were commonly found to be delayed until the early morning hours because of decreased resources at night. Our finding of a slight increase in urgent and emergent cesarean deliveries during the daytime could possibly be explained by a greater Clinical maternal factors such as advanced maternal age, obesity, hypertension, and a history of previous cesarean delivery were associated with an increased OR of undergoing unscheduled cesarean delivery.…”

Section: Discussionmentioning

confidence: 99%

“…Documented risk factors for undergoing an unscheduled cesarean delivery include advanced maternal age, short stature, obesity, large abdominal circumference, large fetal head circumference, fetal distress, and malpresentation 7,9 . Some studies have indicated that the timing of unscheduled cesarean delivery may vary throughout the day, affecting perinatal outcomes, but the extent to which this occurs is not yet fully understood 10,11 …”

Section: Introductionmentioning

confidence: 99%

“…7,9 Some studies have indicated that the timing of unscheduled cesarean delivery may vary throughout the day, affecting perinatal outcomes, but the extent to which this occurs is not yet fully understood. 10,11 Much of the literature on cesarean delivery addresses factors influencing elective procedures and to a lesser extent explores factors that contribute to unscheduled cesarean delivery. In our urban academic tertiary medical center with a medium-sized obstetrical service, we identified a need to investigate any underlying trends specifically affecting unscheduled cesarean deliveries, how fre-…”

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confidence: 99%

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A retrospective review of clinical and non‐clinical factors associated with unscheduled cesarean deliveries at one urban medical center

Hamilton

Drzymalski

2021

Intl J Gynecology & Obste

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Although most births occur by vaginal delivery, certain circumstances may necessitate delivery by cesarean delivery to protect the safety of the mother and the child. 1 Medical indications for cesarean delivery include breech presentation, previous cesarean delivery, active herpes infection, or medically indicative fetal conditions. 2,3 Cesarean deliveries may be elective or unscheduled (either urgent or emergent) and although the procedure itself is considered generally safe, cesarean deliveries-especially unscheduled ones-are

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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A retrospective review of clinical and non‐clinical factors associated with unscheduled cesarean deliveries at one urban medical center

Hamilton

Drzymalski

2021

Intl J Gynecology & Obste

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“…Physicians can be less skilled in relation to natural birth, in comparison to, for example, midwives. [14][15][16][17][18][19][20][21] Hospital factors may also have an effect. 10 22 23 Hospital teaching status is one of hospital characteristics that may explain the variability of CS among hospitals.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Caesarean sections in teaching hospitals: systematic review and meta-analysis of hospitals in 22 countries

et al. 2021

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ObjectiveThe aim of this study is to determine the odds of caesarean section in all births in teaching hospitals as compared with non-teaching hospitals.SettingOver 3600 teaching and non-teaching hospitals in 22 countries. We searched CINAHL, The Cochrane Library, PubMed, sciELO, Scopus and Web of Science from the beginning of records until May 2020.ParticipantsWomen at birth. Over 18.5 million births.InterventionCaesarean section.Primary and secondary outcome measuresThe primary outcome measures are the adjusted OR of caesarean section in a variety of teaching hospital comparisons. The secondary outcome is the crude OR of caesarean section in a variety of teaching hospital comparisons.ResultsIn adjusted analyses, we found that university hospitals have lower odds than non-teaching hospitals (OR=0.66, 95% CI 0.56 to 0.78) and other teaching hospitals (OR=0.46, 95% CI 0.24 to 0.89), and no significant difference with unspecified teaching status hospitals (OR=0.92, 95% CI 0.80 to 1.05, τ2=0.009). Other teaching hospitals had higher odds than non-teaching hospitals (OR=1.23, 95% CI 1.12 to 1.35). Comparison between unspecified teaching hospitals and non-teaching hospitals (OR=0.91, 95% CI 0.50 to 1.65, τ2=1.007) and unspecified hospitals (OR=0.95, 95% CI 0.76 to 1.20), τ2<0.001) showed no significant difference. While the main analysis in larger sized groups of analysed studies reveals no effect between hospitals, subgroup analyses show that teaching hospitals carry out fewer caesarean sections in several countries, for several study populations and population characteristics.ConclusionsWith smaller sample of participants and studies, in clearly defined hospitals categories under comparison, we see that university hospitals have lower odds for caesarean. With larger sample size and number of studies, as well as less clearly defined categories of hospitals, we see no significant difference in the likelihood of caesarean sections between teaching and non-teaching hospitals. Nevertheless, even in groups with no significant effect, teaching hospitals have a lower or higher likelihood of caesarean sections in several analysed subgroups. Therefore, we recommend a more precise examination of forces sustaining these trends.PROSPERO registration numberCRD42020158437.

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“…CS overuse during office hours may also reflect resource availability to perform operative work, or stronger incentives that are enacted via hospital strategies and arrangements, [28][29][30] and/or physicians' incentives, [31] to perform more CS. Other factors may be relevant, including patient preferences, [32] manipulation of timing, [33] or physician practice style, which can be influenced by training and education [34]. We have included a conceptual framework for how office hours may influence CS rates (Additional file 1).…”

Section: Introductionmentioning

confidence: 99%

Office hours and caesarean section: systematic review and Meta-analysis

Hoxha

Lama²,

Bunjaku³

et al. 2022

Res Health Serv Reg

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Background Unnecessary caesarean births may be affected by physician factors, such as preferences, incentives and convenience. Delivery during office hours can be a valuable proxy for measuring such effects. Objective To determine the effect of office hours on the decision for caesarean delivery by assessing the odds of caesarean during office hours compared to out-of-office hours. Search strategy We searched CINAHL, ClinicalTrials.gov, The Cochrane Library, PubMed, Scopus and Web of Science from the beginning of records through August 2021. Data collection and analysis Search results were screened by three researchers. First, we selected studies that reported odds ratios of caesareans, or data allowing their calculation, for office and out-of-office hours. We extracted data on the study population, study design, data sources, setting, type of caesarean section, statistical analysis, and outcome measures. For groups reporting the same outcome, we performed a standard inverse-variance random-effects meta-analysis, which enabled us to calculate the overall odds ratios for each group. For groups reporting varying outcomes, we performed descriptive analysis. Main results Meta-analysis of weekday vs weekend for any caesarean section showed higher odds of caesarean during weekdays in adjusted analysis 1.40 (95%CI 1.13, 1.72 from 1,952,691 births). A similar effect was observed in the weekday vs Sunday comparison (1.39, 95%CI 1.10, 1.75, 150,932 births). A lower effect was observed for emergency CS, with a slight increase in adjusted analysis (1.06, 95%CI 0.90, 1.26, 2,622,772 births) and a slightly higher increase in unadjusted analysis (1.15, 95%CI 1.03, 1.29, 12,591,485 births). Similar trends were observed in subgroup analyses and descriptive synthesis of studies examining other office hours outcomes. Conclusions Delivery during office hours is associated with higher odds for overall caesarean sections and little to no effect for emergency caesarean. Non-clinical factors associated with office hours may influence the decision to deliver by caesarean section. Further detailed investigation of the “office hours effect” in delivery care is necessary and could lead to improvements in care systems. Funding The authors received no direct funding for this study.

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Cesarean section and the manipulation of exact delivery time

Cited by 9 publications

References 33 publications

A retrospective review of clinical and non‐clinical factors associated with unscheduled cesarean deliveries at one urban medical center

A retrospective review of clinical and non‐clinical factors associated with unscheduled cesarean deliveries at one urban medical center

Caesarean sections in teaching hospitals: systematic review and meta-analysis of hospitals in 22 countries

Office hours and caesarean section: systematic review and Meta-analysis

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