Caesarean Delivery in South Italy Women without Choice. A Cross Sectional Survey 英文参考文献.docVIP

CaesareanDeliveryinSouthItaly:Womenwithout Choice.ACrossSectionalSurvey PamelaBarbadoro,CarlosChiatti,MarcelloMarioD’Errico,FrancescoDiStanislao,EmiliaProspero* DepartmentofBiomedicalSciences,Universita` PolitecnicadelleMarche,Ancona,Italy Abstract Background:InspiteoftheWorldHealthOrganization’srecommendationstomaintaincaesareandelivery(CD)between5% and15%oftotalbirths,theratesofCDcontinuetoriseincountrieswithroutineaccesstomedicalservices.AsinItalyCD ratereached38%in2008,thehighestatEUlevel,weevaluatedsocioeconomicandclinicalcorrelatesof‘‘elective’’and‘‘non programmed’’CDintheCountry.Weperformedastratifiedanalysisinordertoverifywhethertheeffectofsuchcorrelates differedamongwomenwithan‘‘apriori’’preferencefornaturalandcaesareandeliveryrespectively. Methods and Findings: We analyzed cross-sectional data from the Italian National Statistics Institute (ISTAT) survey on health condition. Socio-demographic variables, information on maternal care services use and health conditions during pregnancy, as well as maternal preferences on delivery, were available for a representative sample of 2,474 primiparous women.Afteraninitialbivariateanalysis,weusedlogisticregressionstoevaluatefactorsassociatedtothestudyoutcomes. Overall CD accounted for 35.5% of the total births in our sample (CI 33.6–37.4%); moreover, 30.7% (CI 28.6–32.6%) of women preferring natural delivery actually delivered with a CD. Elective CD rate is higher among women over 35 years (22.9%,CI18.8–27.4%),andthoselivingintheSouth(26.2%,CI23.0–29.6%).Themultivariateanalysisshowedthat,even adjustingforseveralconfounders,womenintheSouth,receivingcareintheprivatesectorhadhigherchancesofCD,alsoin caseofpreferencefornaturaldelivery. Conclusion: Policy interventions are required to reduce the rate of undesired CD, e.g. increasing women knowledge regardingdeliveryinordertofavourawarechoices.AneffectivestrategytoreduceCDrateshouldaddresstheSouthern Regions,aswomenhereappeartohaveaverylimitedcontroloverthedelivery,insp