Maternal and neonatal outcomes after implementation of a hospital policy to limit low-risk planned caesarean deliveries before 39weeks of gestation: an interrupted time-seriesanalysis

作者：Hutcheon J A^*; Strumpf E C; Harper S; Gie**recht E

来源：BJOG: An International Journal of Obstetrics and Gynaecology , 2015, 122(9): 1200-1206.

DOI：10.1111/1471-0528.13396

• Early term birth
• elective caesarean
• neonatal morbidity
• time series analysis

ObjectiveTo evaluate the extent to which implementing a hospital policy to limit planned caesarean deliveries before 39weeks of gestation improved neonatal health, maternal health, and healthcare costs.
DesignRetrospective cohort study.
SettingBritish Columbia Women's Hospital, Vancouver, Canada, in the period 2005-2012.
PopulationWomen with a low-risk planned repeat caesarean delivery.
MethodsAn interrupted time series design was used to evaluate the policy to limit planned caesarean deliveries before 39weeks of gestation, introduced on 1April2008.
Main outcome measuresComposite adverse neonatal health outcome (respiratory morbidity, 5-minute Apgar score of <7, neonatal intensive care unit admission, mortality), postpartum haemorrhage, obstetrical wound infection, out-of-hour deliveries, length of stay, and healthcare costs.
ResultsBetween 2005 and 2008, 60% (1204/2021) of low-risk planned caesarean deliveries were performed before 39weeks of gestation. After the introduction of the policy, the proportion of planned caesareans dropped by 20 percentage points (adjusted risk difference of 20 fewer cases per 100 deliveries; 95%CI -25.8,-14.3) to 41% (1033/2518). The policy had no detectable impact on adverse neonatal outcomes (2.2 excess cases per 100; 95%CI -0.4,4.8), maternal complications, or healthcare costs, but increased the risk of out-of-hours delivery from 16.2 to 21.1% (adjusted risk difference 6.3 per 100; 95%CI 1.6,10.9).
ConclusionsWe found little evidence that a hospital policy to limit planned caesareans before 39weeks of gestation reduced adverse neonatal outcomes. Hospital administrators intending to introduce such policies should anticipate, and plan for, modest increases in out-of-hours and emergency-timing.
Tweetable abstract Implementing a policy to limit planned caesareans before 39weeks of gestation did not improve newborn health.

• 出版日期2015-8