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June 27, 1990, Vol 263, No. 24 >
ARTICLE | June 27, 1990

International Differences in the Use of Obstetric Interventions FREE

Francis C Notzon, PhD
[+] Author Affiliations

An earlier version of this study was presented at the World Congress of Gynecology and Obstetrics, Rio de Janeiro, Brazil, October 24,1988.

Reprint requests to National Center for Health Statistics, 6525 Belcrest Rd, Room 1100, Hyattsville, MD 20782 (Dr Notzon).


JAMA. 1990;263(24):3286-3291. doi:10.1001/jama.1990.03440240076019
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References

This study investigated current levels and trends between 1975 and 1986 in the rates of cesarean section in 21 countries and of operative vaginal delivery in 14 countries. Sharp differences in national obstetric practice were found, with cesarean rates ranging from a high of 32 (Brazil) to 7 (Czechoslovakia) per 100 hospital deliveries, and operative vaginal rates from 16 (Canada) to 2 (Czechoslovakia) per 100 hospital deliveries. For most countries, rates of cesarean section have risen as operative vaginal rates have fallen, but some important exceptions exist. A comparison of cesarean section rates for two complications of labor and delivery that can be objectively diagnosed, multiple births and breech delivery, demonstrates that cesarean section rates for these complications rose sharply in almost every country from 1980 to 1985. A comparison of 1985 national rates of intervention and measures of birth outcome found no significant relationship between the two. While such ecological comparisons are imperfect at best, this does indicate that low levels of early infant mortality can be achieved in some populations despite a low rate of cesarean deliveries.

(JAMA. 1990;263:3286-3291)

REFERENCES

1 +
Notzon FC, Placek PJ, Taffel SM.  Comparisons of national cesarean-section rates . N Engl J Med. 1987;;316:386-389.
2 +
Di Renzo GC, Cosmi EV.  Obstetric practice and perinatal outcome: discussion . Eur J Obstet Gynecol Reprod Biol. 1987;;24:143-148.
3 +
Janowitz B, Nakamura MS, Estellita Lins F, Brown ML, Clopton D.  Cesarean section in Brazil . Soc Sci Med. 1982;;16:19-25.
4 +
Rodrigues J.  Urban hospital cesarean section delivery rates in Paraiba State, Brazil, 1977-81 . Am J Public Health. 1988;;78:704-705.
5 +
Kleinman JC.  State trends in infant mortality, 1968-83 . Am J Public Health. 1986;;76:681-687.
6 +
Sempos C, Cooper R, Kovar MG, McMillen M.  Divergence of the recent trends in coronary mortality for the four major race-sex groups in the United States . Am J Public Health. 1988;;78:1422-1427.
7 +
Shiono PH, Fielden JG, McNellis D, Rhoads GG, Pearse WH.  Recent trends in cesarean birth and trial of labor rates in the United States . JAMA. 1987;;257:494-497.
8 +
Lavin JP, Stephens RJ, Miodovnik M, Barden TP.  Vaginal delivery in patients with a previous cesarean section . Obstet Gynecol. 1982;;59:135-148.
9 +
Anderson GM, Lomas J.  Determinants of the increasing cesarean rate: Ontario data 1979 to 1982 . N Engl J Med. 1984;;311:887-892.
10 +
Malloy MH, Rhoads GG, Schramm W, Land G.  Increasing cesarean section rates in very low-birth weight infants: effect on outcome . JAMA. 1989;;262:1475-1478.
11 +
Bergsjo P, Schmidt E, Pusch D.  Differences in the reported frequencies of some obstetrical interventions in Europe . Br J Obstet Gynecol. 1983;; 90:628-632.
12 +
Leveno KJ, Cunningham FG, Nelson S, Roark M, et al.  A prospective comparison of selective and universal electronic fetal monitoring in 34,995 pregnancies . N Engl J Med. 1986;;315:615-619.
13 +
Gibbs CE.  Planned vaginal delivery following cesarean section . Clin Obstet Gynecol. 1980;;23: 507-515.
14 +
Martin JN Jr, Harris BA Jr, Huddleston JF, et al.  Vaginal delivery following previous cesarean birth . Am J Obstet Gynecol. 1983;;146:255-263.
15 +
Gellman E, Goldstein MS, Kaplan S, Shapiro WJ.  Vaginal delivery after cesarean section: experience in private practice . JAMA. 1983;;249:2935-2937.
16 +
Myers SA, Gleicher N.  A successful program to lower cesarean-section rates . N Engl J Med. 1989;; 319:1511-1516.
17 +
Needham, Porter, Novelli. Professional Liability Insurance and Its Effect: Report of a Survey of ACOG's Membership: November 1985 . Washington, DC: Needham Harper Worldwide Inc; 1985;. Prepared for the American College of Obstetricians and Gynecologists.
18 +
Porter, Novelli, and Associates. Professional Liability Insurance and Its Effects: Report of a Survey of ACOG's Membership . Washington, DC: American College of Obstetricians and Gynecologists; 1983;.
19 +
Opinion Research Corporation. Professional Liability and Its Effects: Report of a 1987 Survey of ACOG's Membership . Washington, DC: American College of Obstetricians and Gynecologists; 1988;.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Notzon FC, Placek PJ, Taffel SM.  Comparisons of national cesarean-section rates . N Engl J Med. 1987;;316:386-389.
2 +
Di Renzo GC, Cosmi EV.  Obstetric practice and perinatal outcome: discussion . Eur J Obstet Gynecol Reprod Biol. 1987;;24:143-148.
3 +
Janowitz B, Nakamura MS, Estellita Lins F, Brown ML, Clopton D.  Cesarean section in Brazil . Soc Sci Med. 1982;;16:19-25.
4 +
Rodrigues J.  Urban hospital cesarean section delivery rates in Paraiba State, Brazil, 1977-81 . Am J Public Health. 1988;;78:704-705.
5 +
Kleinman JC.  State trends in infant mortality, 1968-83 . Am J Public Health. 1986;;76:681-687.
6 +
Sempos C, Cooper R, Kovar MG, McMillen M.  Divergence of the recent trends in coronary mortality for the four major race-sex groups in the United States . Am J Public Health. 1988;;78:1422-1427.
7 +
Shiono PH, Fielden JG, McNellis D, Rhoads GG, Pearse WH.  Recent trends in cesarean birth and trial of labor rates in the United States . JAMA. 1987;;257:494-497.
8 +
Lavin JP, Stephens RJ, Miodovnik M, Barden TP.  Vaginal delivery in patients with a previous cesarean section . Obstet Gynecol. 1982;;59:135-148.
9 +
Anderson GM, Lomas J.  Determinants of the increasing cesarean rate: Ontario data 1979 to 1982 . N Engl J Med. 1984;;311:887-892.
10 +
Malloy MH, Rhoads GG, Schramm W, Land G.  Increasing cesarean section rates in very low-birth weight infants: effect on outcome . JAMA. 1989;;262:1475-1478.
11 +
Bergsjo P, Schmidt E, Pusch D.  Differences in the reported frequencies of some obstetrical interventions in Europe . Br J Obstet Gynecol. 1983;; 90:628-632.
12 +
Leveno KJ, Cunningham FG, Nelson S, Roark M, et al.  A prospective comparison of selective and universal electronic fetal monitoring in 34,995 pregnancies . N Engl J Med. 1986;;315:615-619.
13 +
Gibbs CE.  Planned vaginal delivery following cesarean section . Clin Obstet Gynecol. 1980;;23: 507-515.
14 +
Martin JN Jr, Harris BA Jr, Huddleston JF, et al.  Vaginal delivery following previous cesarean birth . Am J Obstet Gynecol. 1983;;146:255-263.
15 +
Gellman E, Goldstein MS, Kaplan S, Shapiro WJ.  Vaginal delivery after cesarean section: experience in private practice . JAMA. 1983;;249:2935-2937.
16 +
Myers SA, Gleicher N.  A successful program to lower cesarean-section rates . N Engl J Med. 1989;; 319:1511-1516.
17 +
Needham, Porter, Novelli. Professional Liability Insurance and Its Effect: Report of a Survey of ACOG's Membership: November 1985 . Washington, DC: Needham Harper Worldwide Inc; 1985;. Prepared for the American College of Obstetricians and Gynecologists.
18 +
Porter, Novelli, and Associates. Professional Liability Insurance and Its Effects: Report of a Survey of ACOG's Membership . Washington, DC: American College of Obstetricians and Gynecologists; 1983;.
19 +
Opinion Research Corporation. Professional Liability and Its Effects: Report of a 1987 Survey of ACOG's Membership . Washington, DC: American College of Obstetricians and Gynecologists; 1988;.

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