Cesarean section on a rise—Does advanced maternal age explain the increase? A population register-based study

Rydahl, Eva; Declercq, Eugene; Juhl, Mette; Maimburg, Rikke Damkjær

doi:10.1371/journal.pone.0210655

Cited by 126 publications

(127 citation statements)

References 44 publications

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“…Several previous studies document a significant association between advanced maternal age (>35 years) and an increased likelihood of CS birth [19,20]. This association may be interpreted as a result of a changing social environment, but a common explanation is the pre-pregnancy morbidities associated in these cases [21]. However, as noted in Table 4, only a few women that constitute our study presented comorbidity and, none of them had the age reported, as was not required for the RTGCS.…”

Section: Discussionmentioning

confidence: 97%

Analysis of Caesarean Section Rates Using the Robson Classification System at a University Hospital in Spain

Vila‐Candel

Martín

Escuriet

et al. 2020

IJERPH

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Background: The WHO recommends the use of the Robson ten-group classification system (RTGCS) as an effective monitoring and analysis tool to assess the use of caesarean sections (CS). The present study aimed to conduct an analysis of births using the RTGCS in La Ribera University Hospital over nine years and to assess the levels and trends of CS births. Methods: Retrospective study between January 1, 2010, and December 31, 2018. All eligible women were allocated in RTGCS to determine the absolute and relative contribution made by each group to the overall CS rate; linear regression and weighted least squares regression analysis were used to analyze trends over time. The risk of CS of women with induced versus spontaneous onset of labor was calculated with an odds ratio (OR) with a 95% CI. Results: 16,506 women gave birth during the study period, 19% of them by CS. Overall, 20.4% of women were in group 1 (nulliparous, singleton cephalic, term, spontaneous labor), 29.4% in group 2 (nulliparous, singleton cephalic, term, induced labor or caesarean before labor), and 12.8% in group 4 (multiparous, singleton cephalic, term, induced or caesarean delivery before labor) made the most significant contributions to the overall rate of CS; Conclusions: In our study, Robson Groups 1, 2, and 4, were identified as the main contributors to the hospital's overall CS rate. The RTGCS provides an easy way of collecting information about the CS rate, is a valuable clinical method that allows standardized comparison of data, and time point, and identifies the groups driving changes in CS rates. justification do not reduce maternal or infant death rates if carried out at a rate higher than 10%-15% [2]. The unjustified, excessive use of clinical procedures can lead to an ever-increasing therapeutic cascade of avoidable interventions [3] and become life-threatening in the present or future pregnancies for both the women and children [4]. The worldwide rise in CS rates has become a growing public health concern and a cause for debate due to potential maternal and perinatal risks, cost issues, and inequity in access [5].There is a high degree of variability in the reported crude rates of CS performed in different countries and regions, and there are often even significant differences between hospitals within a single region. The highest caesarean rates are observed in the Dominican Republic (56.4%), Brazil (55.6%), and Egypt (51.8%), with Africa (7.3%) showing the lowest proportion of these procedures [1]. In most European countries, the rates are about 25% to 35% [5]. In Spain, the average CS rate reported across the 17 autonomous communities, the governing entities independently responsible for health care [6] and for deploying health resources to serve the needs of their local populations, was found to be 24.5% in 2015 [7,8]. However, due to the decentralized structure of the health system, there is no nationally established system to monitor the use of caesarean procedures.Achieving reductions in maternal and infant morbidity and morta...

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Section: Discussionmentioning

confidence: 97%

Analysis of Caesarean Section Rates Using the Robson Classification System at a University Hospital in Spain

Vila‐Candel

Martín

Escuriet

et al. 2020

IJERPH

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“…Therefore, our results suggest a multifaceted approach to define AMA in today’s society. Ideally, this should help spare both physicians and patients from ungrounded fears related to ENM, which has been shown to lead to unreasonably low thresholds for obstetric intervention and primary cesarean section 27 , 28 .…”

Section: Discussionmentioning

confidence: 99%

Maternal age and risk of early neonatal mortality: a national cohort study

Kim

Choi

Kim

et al. 2021

Sci Rep

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Advanced maternal age (AMA) is a growing trend world-wide and is traditionally defined as childbearing in women over 35 years of age. The purpose of our study was to determine the maternal age group within the Korean population, in which the risk of early neonatal mortality is increased. Korean birth and mortality data from 2011 to 2015 were used to estimate the influence of maternal age on the risk of early neonatal mortality. A Poisson regression was used for the analysis of multiple clinical variables such as year of delivery, maternal age, gestational age, infant gender, birth weight, multiple birth, parity, and socioeconomic variables. Furthermore, a generalized additive model was used to determine the maternal age at which the risk for neonatal mortality increases. We included 2,161,908 participants and found that 49.4% of mothers were 30–34 years of age at delivery. The proportion of mothers aged 35 and above increased over the 5-year analysis period. A maternal age lower than 29 years or higher than 40 years was associated with a relatively higher risk of early neonatal mortality. The trend and magnitude of the age-related risk on early neonatal mortality were independent of maternal socioeconomic factors such as living in an obstetrically underserved area, education level, and employment status. Furthermore, we showed that the risk for early neonatal mortality was higher until the maternal age of 28. However, there were no significant changes in the risk between the age of 35 and 40 years. According to recent national-wide data, age-related risk for early neonatal mortality is only apparent for mothers ≥ 40 years old whereas, age between 35 and 39 are not at increased risk for early neonatal mortality, despite being classified as AMA.

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“…The finding of higher cesarean rates for Black mothers is consistent with prior research [ 37 – 39 ], though the differences identified here (aOR 2.40) after adjustment are greater than in those studies. Likewise, the finding of higher cesarean rates for older [ 40 ] and less educated mothers has been regularly confirmed [ 41 ]. The positive relationship between age and cesarean birth appears to be well-established [ 18 ].…”

Section: Discussionmentioning

confidence: 94%

Factors Associated with Unplanned Primary Cesarean Birth: Secondary Analysis of the Listening to Mothers in California Survey

Sakala

Belanoff

Declercq

2020

BMC Pregnancy Childbirth

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Background: In many countries, cesarean section has become the most common major surgical procedure. Most nations have high cesarean birth rates, suggesting overuse. Due to the excess harm and expense associated with unneeded cesareans, many health systems are seeking approaches to safe reduction of cesarean rates. Surveys of childbearing women are a distinctive and underutilized source of data for examining factors that may contribute to cesarean reduction. Methods: To identify factors associated with unplanned primary cesarean birth, we carried out a secondary analysis of the Listening to Mothers in California Survey, limited to the subgroup who had not had a previous cesarean birth and did not have a planned primary cesarean (n = 1,964). Participants were identified through birth certificate sampling and contacted initially by mail and then by telephone, text message and email, as available. Sampled women could participate in English or Spanish, on any device or with a telephone interviewer. Following bivariate demographic, knowledge and attitude, and labor management analyses, we carried out multivariable analyses to adjust with covariates and identify factors associated with unplanned primary cesarean birth. Results: Whereas knowledge, attitudes, preferences and behaviors of the survey participants were not associated with having an unplanned primary cesarean birth, their experience of pressure from a health professional to have a cesarean and a series of labor management practices were strongly associated with how they gave birth. These practices included attempted induction of labor, early hospital admission, and labor augmentation. Women's reports of pressure from a health professional to have a primary cesarean were strongly related to the likelihood of cesarean birth. Conclusions: While women largely wish to avoid unneeded childbirth interventions, their knowledge, preferences and care arrangement practices did not appear to impact their likelihood of an unplanned primary cesarean birth. By contrast, a series of labor management practices and perceived health professional pressure to have a cesarean were associated with unplanned primary cesarean birth. Improving ways to engage childbearing women and implementing changes in labor management and communication practices may be needed to reduce unwarranted cesarean birth.

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Cesarean section on a rise—Does advanced maternal age explain the increase? A population register-based study

Cited by 126 publications

References 44 publications

Analysis of Caesarean Section Rates Using the Robson Classification System at a University Hospital in Spain

Analysis of Caesarean Section Rates Using the Robson Classification System at a University Hospital in Spain

Maternal age and risk of early neonatal mortality: a national cohort study

Factors Associated with Unplanned Primary Cesarean Birth: Secondary Analysis of the Listening to Mothers in California Survey

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