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A REVIEW OF CESAREAN SECTION STATISTICS IN A COMMUNITY AND IN THE UNITED-STATES

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AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY 1954年第4期68卷 1082-1090页

作者： SCHNEIDER, B From the Jewish Hospital Louisville Ky.

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PERINATAL MORTALITY ASSOCIATED WITH CESAREAN SECTION

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AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY 1956年第2期71卷 304-309页

作者： MCNEILL, DB From the University of Buffalo School of Medicine the Buffalo General Hospital and Children's Hospital Buffalo N. Y.

1. A report is presented of the perinatal mortality associated with cesarean section, with a review of 944 cesarean sections with respect to the factors accounting for the infant loss.2. The perinatal mortality with cesarean section is approximately twice as high as the over-all perinatal loss in all types of delivery.3. Neither the type of anesthesia nor the type of operation seemed to have any particular bearing on the ultimate outcome of the newborn.4. Forty per cent of the perinatal loss can be attributed to asphyxia due to placenta praevia and placentae abruptio.5. Almost 50 per cent of the perinatal loss can be attributed to emergency situations where there is little chance for fetal salvage.6. The perinatal mortality in strictly elective cesarean sections is slightly higher than the over-all perinatal mortality.7. There appears to be an inherent perinatal loss with cesarean section of approximately 1 per cent, in which death could be attributable only to "hyaline membrane disease" or atelectasis. However, of the 8 infants who died of these causes in the elective cesarean sections, 5 were premature.8. In those cesarean sections indicated by fetopelvic disproportion theperinatal outcome appears to be somewhat better than the over-all loss in alltypes of vaginal delivery.9. Approximately 10 per cent of the perinatal loss can be attributed directly to prematurity. In an additional 25 per cent, prematurity was a contributing cause leading to death.

关键词：生物统计学剖宫产术/统计学和数值数据婴儿新生/统计学和数值数据围产期死亡率女(雌)性人类妊娠

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CESAREAN SECTION IN CINCINNATI, OHIO - 1950 THROUGH 1954

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AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY 1956年第3期71卷 614-633页

作者： BRYANT, RD Cincinnati Ohio USA

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Trends in births at and beyond term: evidence of a change?

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BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1999年第9期106卷 937-942页

作者： Roberts, CL Taylor, L Henderson-Smart, D Univ Sydney NSW Ctr Perinatal Hlth Serv Res Sydney NSW 2006 Australia Univ Sydney Dept Obstet & Gynaecol Sydney NSW 2006 Australia Univ Sydney Dept Publ Hlth & Community Med Sydney NSW 2006 Australia New S Wales Hlth Dept Surveillance Methods Publ Hlth Div Sydney NSW Australia

Objective To examine trends in the distribution of births at and beyond term in New South Wales and in particular, to determine whether any changes are associated with changes in the obstetric practices of induction and elective caesarean section. Design Cross-sectional analytic study. Setting New South Wales, Australia. Population All 540,162 women delivering a singleton cephalic-presenting infant of gestational age greater than or equal to 37 weeks from 1 January 1990 to 31 December 1996. Methods Data were obtained from the New South Wales midwives data collection, a population-based surveillance system covering all births in New South Wales. The data were analysed to examine changes over time and associations between gestational age, maternal factors and onset of labour. Main outcome measures Induction of labour and elective caesarean section rates. Results From 1990 to 1996 there was a significant decrease in births reported as 40 weeks of gestation, from 35,670 (46.3%) to 30,651 (40.3%). These declines were offset by significant increases in births at 38 and 39 weeks. Births greater than or equal to 42 weeks declined from 3321 (4.6%) to 2132 (2.8%). The decline in prolonged pregnancies was associated with increasing induction rates at 41 weeks. The re-distribution of some births from 40 to 38-39 weeks was associated with increasing rates of elective caesarean sections and induction at 38 and 39 weeks, and increasing maternal age. Conclusions Clinicians appear to be implementing the recommendations of randomised controlled trials to offer induction after 41 weeks of gestation. However the trend of performing elective caesarean sections at earlier gestational ages may be unnecessarily putting some infants at increased risk of respiratory morbidity.

关键词：剖宫产术/统计学和数值数据剖宫产术/发展趋势横断面研究引产/统计学和数值数据引产/发展趋势母亲年龄新南威尔士/流行病学妊娠过期产前保健/统计学和数值数据产前保健/发展趋势成年人女(雌)性人类妊娠

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A STUDY OF CESAREAN SECTION AT EVANSTON HOSPITAL FROM 1930 TO 1950

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AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY 1953年第5期65卷 953-959页

作者： ZETTELMAN, HJ BOWERS, VM Department of Obstetrics and Gynecology Northwestern University Medical School Evanston Ill. USA

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Intrapartum amnioinfusion for meconium-stained fluid: Meta-analysis of prospective clinical trials

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OBSTETRICS AND GYNECOLOGY 2000年第6期95卷 1051-1056页

作者： Pierce, J Gaudier, FL Sanchez-Ramos, L Univ Florida Hlth Sci Ctr Dept Obstet & Gynecol Div Maternal Fetal Med Jacksonville FL 32209 USA

Objective: To evaluate the effectiveness of intrapartum prophylactic amnioinfusion in pregnancies complicated by meconium-stained amniotic fluid. Data Sources: We identified prospective clinical trials of amnioinfusion in pregnancies complicated by meconium-stained amniotic fluid (AF) published in English by using computerized databases, references in published studies, and index reviews. Methods of Study Selection: We analyzed prospective studies of intrapartum amnioinfusion for meconium-stained AF. In every case, group allocation was based exclusively on meconium in AF. Only published studies with clearly documented outcome data were included. The trials were evaluated for meconium below the vocal cords, meconium aspiration syndrome, fetal acidemia, cesarean delivery, and postpartum endometritis. Each trial was evaluated for the quality of its methodology, inclusion and exclusion criteria, adequacy of randomization, amnioinfusion protocols, definition of outcomes, and statistical analyses. Tabulation, Integration, and Results: Thirteen studies met inclusion criteria for our systematic review. Odds ratios (ORs) with their 95% confidence intervals (CIs) were calculated for each outcome. Estimates of ORs and risk differences for dichotomous outcomes were calculated using random and fixed-effects models. We tested for homogeneity across the studies. We found that intrapartum amnioinfusion significantly reduced the frequency of meconium aspiration syndrome (OR 0.30;95% CI 0.19, 0.46), of meconium below the vocal cords, and neonatal acidemia. Subjects allocated to receive amnioinfusion also had a significantly lower overall cesarean rate (OR 0.74, 95% CI 0.59, 0.93) without increased postpartum endometritis. Conclusion: Amnioinfusion in cases of meconium-stained fluid significantly improves neonatal outcome, lowers the cesarean delivery rate, and does not increase the postpartum endometritis rate. (Obstet Gynecol 2000;95:1051-6. (C) 2000 by The American College of Obste

关键词：羊膜羊水剖宫产术/统计学和数值数据临床试验(主题) 胎粪胎粪吸入综合征/预防和控制分娩并发症/预防和控制前瞻性研究女(雌)性人类婴儿新生妊娠

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Lack of progress in labor as a reason for cesarean

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OBSTETRICS AND GYNECOLOGY 2000年第4期95卷 589-595页

作者： Gifford, DS Morton, SC Fiske, M Keesey, J Keeler, E Kahn, KL Brown Univ Women & Infants Hosp Dept Obstet & Gynecol Providence RI 02905 USA RAND Santa Monica CA USA Univ Calif Los Angeles Sch Med Dept Med Los Angeles CA 90024 USA

Objective: To estimate the prevalence of lack of progress in labor as a reason for cesarean delivery and to compare published diagnostic criteria with the labor characteristics of women with this diagnosis. Methods: We reviewed medical records and did a postpartum telephone survey to collect data from 733 women who delivered full-term, nonbreech infants by unplanned cesarean between March 1993 and February 1994. These were a subset of 2447 births sampled at delivery from 30 hospitals in Los Angeles County and Iowa. We measured the proportion of unplanned cesareans done for lack of progress in labor, the cervical dilatation at the time of cesarean, length of the second stage, and slope of the active phase among the women. We estimated the proportion of these cesareans that conformed to the ACOG criteria for the diagnosis of lack of progress. Results: Lack of progress was a reason for 68% of unplanned, vertex cesareans. At least 16% of the subjects who had cesareans for lack of progress were in the latent phase of labor according to ACOG criteria. The second stage was not prolonged in 36% of the women who delivered at 10 cm. Conclusion: Lack of progress in labor is a dominant reason for cesarean delivery. Many cesareans are done during the latent phase of labor, and in the second stage of labor when it is not prolonged. These practices do not conform to published diagnostic criteria for lack of progress. (C) 2000 by The American College of Obstetricians and Gynecologists.

关键词：剖宫产术/统计学和数值数据分娩并发症/流行病学分娩并发症/外科学患病率时间因素青少年成年人女(雌)性人类妊娠

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CESAREAN SECTION IN MULTIPLE PREGNANCIES

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AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY 1956年第1期72卷 19-24页

作者： BRODY, S From the Department of Obstetrics and Gynecology of the Unity Hospital Brooklyn N.Y

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Extra-amniotic saline, laminaria, or prostaglandin E₂ gel for labor induction with unfavorable cervix:: A randomized controlled trial

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OBSTETRICS AND GYNECOLOGY 2000年第1期96卷 106-112页

作者： Guinn, DA Goepfert, AR Christine, M Owen, J Hauth, JC Univ Alabama Dept Obstet & Gynecol Div Maternal Fetal Med Birmingham AL 35294 USA

Objective: To determine which of three methods of cervical ripening resulted in the lowest cesarean rate in women with unfavorable cervices and indications for labor induction. Methods: Consenting women with singleton gestations, vertex presentations, and unfavorable cervices (dilatation under 2 cm and effacement under 75%) were randomly assigned to laminaria and standard intravenous oxytocin, serial doses of intracervical prostoglandin (PG) E-2 gel (Prepidil, Pharmacia & Upjohn, Inc., Kalamazoo, MI) 0.5 mu g every 6 hours for two doses followed by oxytocin if indicated, or extra-amniotic saline infusion and oxytocin. Results: An interim analysis after recruitment of 321 subjects, 67% of the planned sample, found similar cesarean rates for the three groups (laminaria 36%;PGE(2) gel 33%;saline infusion 29%;P = .59);however, the mean randomization-to-delivery interval was significantly longer in the PGE(2) group. Stochastic curtailment, as part of the interim analysis, indicated a low likelihood of achieving a statistically significant difference in cesarean rates between PGE(2) gel and the other two groups. Therefore, we completed the study with saline infusion and laminaria. The saline infusion and Laminaria groups had similar preinduction characteristics. The cesarean rates were similar (saline infusion 25.4% versus laminaria 30.3%;P = .32), but the mean interval from randomization to delivery was shorter in the saline infusion group (18.0 versus 21.5 hours, P = .002). There were no significant differences in selected maternal and neonatal morbidities. Conclusion: Cervical ripening with extra-amniotic saline infusion, PGE(2), or laminaria resulted in comparable cesarean rates in women with an unfavorable cervix and indications for labor induction. Extra-amniotic saline infusion had the shortest randomization-to-delivery interval without increasing maternal or neonatal morbidity. (Obstet Gynecol 2000;96:106-12. (C) 2000 by The American College of Obstetricians and G

关键词：宫颈成熟剖宫产术/统计学和数值数据地诺前列酮引产海带属催产药盐水高渗成年人女(雌)性人类妊娠

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CESAREAN SECTION MORTALITY

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AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY 1956年第6期71卷 1194-1201页

作者： BISHOP, EH Philadelphia Pa. USA

Recent reports of large series of cesarean sections performed at various maternity centers throughout the country have, almost without exception, presented maternal mortality rates reduced to almost the ideal minimum. While these reports are admirable and the results are enviable, unfortunately, they tend to create a false impression, especially among the less experienced members of the profession—that cesarean section has become a procedure with minimal risk to the patient which does not need the same serious consideration accorded to other major surgical *** reduction of maternal mortality has been brought about by many advances in obstetrie care. Among the most important are: (1) more thorough training of obstetricians; (2) the increased percentage of deliveries performed by obstetricians; (3) requirements for competent consultation for all obstetric complications; (4) blood banks; (5) antibiotic and chemotherapeutic drugs; and (6) improved obstetric *** a result of these improvements in obstetric care, deaths associated with cesarean section have become so rare that no one individual nor even any one hospital staff has enough experience to realize that preventable cesarean section deaths still occur frequently enough to constitute an important problem at the present time. This fact can be appreciated only by a critical review of the deaths which occur among a large section of the population, such as a metropolitan area. This presentation, therefore, is an analysis of the maternal deaths associated with the cesarean sections which were performed in the City of Philadelphia from Jan. 1, 1938, to Dec. 31. 1953. The information was obtained from reports submitted to the Committee on Maternal Welfare of the Philadelphia County Medical *** comparative purposes, this study will be divided into two eight-year periods, 1938–1945 and 1945–1953. This division occurred at a natural point because during the second eight-year period an easily obta

关键词：剖宫产术/统计学和数值数据女(雌)性人类妊娠

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