Evidence map›Paper›PMID 20926490›Full record

ArticleBMJ (Clinical research ed.)2010

Variation in rates of caesarean section among English NHS trusts after accounting for maternal and clinical risk: cross sectional study.

Fiona Bragg, David A Cromwell, Leroy C Edozien, Ipek Gurol-Urganci, Tahir A Mahmood, Allan Templeton, Jan H van der Meulen

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ (Clinical research ed.), 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 82 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
82citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

82 citing papers in PubMed, 7 syntheses or guidelines pooled it.

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  12. Postnatal unit bassinet types when rooming-in after cesarean birth: implications for breastfeeding and infant safety.Journal of human lactation : official journal of International Lactation Consultant Association · 2012
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  18. Mode of delivery and maternal sexual wellbeing: A longitudinal study.BJOG : an international journal of obstetrics and gynaecology · 2022
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22 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Fiona BraggLondon School of Hygiene and Tropical Medicine, London, UK.
David A Cromwell
Leroy C Edozien
Ipek Gurol-Urganci
Tahir A Mahmood
Allan Templeton
Jan H van der Meulen

Funding

Department of Health
6 · The paper itself

Abstract

objectiveTo determine whether the variation in unadjusted rates of caesarean section derived from routine data in NHS trusts in England can be explained by maternal characteristics and clinical risk factors.

designA cross sectional analysis using routinely collected hospital episode statistics was performed. A multiple logistic regression model was used to estimate the likelihood of women having a caesarean section given their maternal characteristics (age, ethnicity, parity, and socioeconomic deprivation) and clinical risk factors (previous caesarean section, breech presentation, and fetal distress). Adjusted rates of caesarean section for each NHS trust were produced from this model.

setting146 English NHS trusts. Population Women aged between 15 and 44 years with a singleton birth between 1 January and 31 December 2008.

main outcome measureRate of caesarean sections per 100 births (live or stillborn).

resultsAmong 620 604 singleton births, 147 726 (23.8%) were delivered by caesarean section. Women were more likely to have a caesarean section if they had had one previously (70.8%) or had a baby with breech presentation (89.8%). Unadjusted rates of caesarean section among the NHS trusts ranged from 13.6% to 31.9%. Trusts differed in their patient populations, but adjusted rates still ranged from 14.9% to 32.1%. Rates of emergency caesarean section varied between trusts more than rates of elective caesarean section.

conclusionCharacteristics of women delivering at NHS trusts differ, and comparing unadjusted rates of caesarean section should be avoided. Adjusted rates of caesarean section still vary considerably and attempts to reduce this variation should examine issues linked to emergency caesarean section.

Indexed as

AdolescentAdultCesarean SectionCross-Sectional StudiesEnglandFemaleHumansPregnancyPregnancy ComplicationsRegression AnalysisRisk FactorsState MedicineYoung Adult

Identifiers

PMID20926490
PMCPMC2950923

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.