the timing of elective caesarean delivery between 2000 and 2009 in england选择性剖腹产手术的时机在英格兰在2000年和2009年之间.pdfVIP

Gurol-Urganci et al. BMC Pregnancy and Childbirth 2011, 11:43 /1471-2393/11/43 RESEARCH ARTICLE Open Access The timing of elective caesarean delivery between 2000 and 2009 in England 1,2* 1,2 3 2 2 Ipek Gurol-Urganci , David A Cromwell , Leroy C Edozien , Chidimma Onwere , Tahir A Mahmood and Jan H van der Meulen 1 Abstract Background: In 2004, the National Institute for Clinical Excellence (NICE) recommended that an elective caesarean section for an uncomplicated pregnancy should not be carried out before 39 completed weeks due to increased risk of respiratory morbidity in newborns. We describe the trends and variation across 63 English NHS trusts in the timing of elective caesarean section (CS) for low-risk singleton deliveries. Methods: We identified elective CS deliveries between 1st April 2000 and 28th February 2009 in English NHS trusts using the Hospital Episode Statistics. We selected women with uncomplicated pregnancies who had an elective CS delivery after 34 completed weeks of gestation, and analysed the trends and the trust-level variation in the timing of elective CS. The impact of the NICE guidance on the monthly rate of elective CS deliveries performed after 39 weeks was estimated using an interrupted time-series design with autoregressive integrated moving average (ARIMA). Results: There were 118,456 elective CS deliveries at the 63 NHS trusts. The overall proportion of elective CS deliveries done after 39 completed weeks steadily increased from 39% in 2000/01 to 63% in 2008/09. The proportions rose from 43% to 67% for women with breech presentation and from 35% to 62% for women with a previous CS. There was significant variation across NHS trusts in each