Orleans M, Haverkamp AD, Leff M, Lezotte D; International Society of Technology Assessment in Health Care. Meeting.

Abstr Int Soc Technol Assess Health Care Meet. 1992; 15.

University of Colorado Health Science, Denver.

BACKGROUND. The steady rise in C-section rates in the United States in the past two decades appears to have leveled, following recent efforts to encourage trials of labor among women who had experienced previous C-sections. During the long period of increase, in public and non-profit hospitals, C-section rates were reported in many studies to have been lower than national rates. At Kaiser Permanente in Denver, rates dropped from 16.2 to 12.6 percent between 1986-1989, raising questions as to whether the lowered rates were too low. "Appropriate8 rates have never been established. There are no ACOG guidelines, to which obstetricians and family practicers might try to conform. There are only guidelines regarding vaginal births after C-sections (VBACs). METHODS. A recent study was conducted at Kaiser, Denver of 8,390 births occurring between July, 1986 and December, 1989. The objectives of the study were to compare any adverse outcomes associated with various modes of delivery (C-section, spontaneous and assisted vaginal deliveries, the latter including forceps and vacuum extraction). Since many decisions regarding the mode of delivery are reactions to underlying maternal and fetal problems, we considered only those outcomes that were most clearly associated with the delivery method itself. We matched mothers and infants, relying on unmatched discharge data provided by St. Joseph Hospital, in which the deliveries took place. We matched mothers and infants, relying on unmatched discharge data provided by St. Joseph Hospital, in which the deliveries took place. We recorded all instances of obstetrical trauma, e.g., 30 degrees and 40 degrees lacerations, postpartum hemorrhage, surgical wounds, hematomas, etc. Infant trauma included subdural and cerebral hemorrhage, injuries to scalp, skeleton, spine, and clavicle fracture. During each year of the study, there was significantly less trauma to infants who were delivered spontaneously. RESULTS. The results for mothers were mixed. Obviously all C-sectioned mothers had surgical wounds; they also experienced more infection. The highest incidence of hemorrhage and 30 degrees and 40 degrees lacerations occurred during forceps deliveries. The decreasing C-section rate was not accompanied by increased trauma or morbidity among mothers or infants. CONCLUSION. In this study, lower rates of C-section were "appropriate8 in that no increased morbidity resulted. We hope that investigators will consider the question of "appropriateness8 in other higher-risk settings.

Publication Types:

• Meeting Abstracts

Keywords:

• Case-Control Studies
• Delivery, Obstetric
• Evaluation Studies
• Female
• Fractures, Bone
• Humans
• Infant
• Mothers
• Obstetric Labor Complications
• Pregnancy
• Pregnancy Complications
• United States
• Vacuum Extraction, Obstetrical
• methods
• surgery
• hsrmtgs

Other ID:

• HTX/94910505

UI: 102211859

From Meeting Abstracts