Evidence map›Paper›PMID 30082355›Full record

Observational studyBMJ open2018

In which groups of pregnant women can the caesarean delivery rate likely be reduced safely in the USA? A multicentre cross-sectional study.

Jin-Wen Zhang, Ware Branch, Matthew Hoffman, Ank De Jonge, Sheng-Hui Li, James Troendle, Jun Zhang

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

Observational study in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–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

5 citing papers in PubMed.

  1. Where the Ockenden report goes wrong: Let us keep calm and follow the evidence.BJOG : an international journal of obstetrics and gynaecology · 2023
    Article
  2. Association between weighted adverse outcome score and race/ethnicity in women and neonates.Journal of perinatology : official journal of the California Perinatal Association · 2021
    Article
  3. Article
  4. Article
  5. Effect of implementation of the MOREBMC pregnancy and childbirth · 2019
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Jin-Wen ZhangSchool of Public Health, Shanghai Jiao Tong University, Shanghai, China.
Ware BranchIntermountain Healthcare and University of Utah, Utah, USA.
Matthew HoffmanChristiana Healthcare, Delaware, USA.
Ank De JongeAVAG and the Amsterdam University Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.ORCID 0000-0002-5384-3744
Sheng-Hui LiSchool of Public Health, Shanghai Jiao Tong University, Shanghai, China.
James TroendleNational Institute of Heart, Lung and Blood Institute, National Institutes of Health, Maryland, USA.
Jun ZhangSchool of Public Health, Shanghai Jiao Tong University, Shanghai, China.

Funding

NICHD NIH HHS HHSN267200603425C
6 · The paper itself

Abstract

objectivesTo identify obstetrical subgroups in which (1) the caesarean delivery (CD) rate may be reduced without compromising safety and (2) CD may be associated with better perinatal outcomes.

designA multicentre cross-sectional study.

setting19 hospitals in the USA that participated in the Consortium on Safe Labor.

participants228 562 pregnant women in 2002-2008.

main outcome measuresMaternal and neonatal safety was measured using the individual Weighted Adverse Outcome Score.

methodsWomen were divided into 10 subgroups according to a modified Robson classification system. Generalised estimated equation model was used to examine the relationships between mode of delivery and Weighted Adverse Outcome Score in each subgroup.

resultsThe overall caesarean rate was 31.2%. Repeat CD contributed 29.5% of all CD, followed by nulliparas with labour induction (15.3%) and non-cephalic presentation (14.3%). The caesarean rates in induced nulliparas with a term singleton cephalic pregnancy and women with previous CD were 31.6% and 82.0%, respectively. CD had no clinically meaningful association with perinatal outcomes in most subgroups. However, in singleton preterm breech presentation and preterm twin gestation with the first twin in non-cephalic presentation, CD was associated with substantially improved maternal and perinatal outcomes.

conclusionsWomen with repeat CD, term non-cephalic presentation, term twins or other multiple gestation and preterm births may be the potential targets for safely reducing prelabour CD rate, while nulliparas or multiparas with spontaneous or induced labour, women with repeat CD, term non-cephalic presentation, term twins or other multiple gestation and preterm births are potential targets for reducing intrapartum CD rate without compromising maternal and neonatal safety in the USA. On the other hand, CD may still be associated with better perinatal outcomes in women with singleton preterm breech presentation or preterm twins with the first twin in non-cephalic presentation.

Indexed as

Patient SafetyBreech PresentationCesarean SectionCesarean Section, RepeatCross-Sectional StudiesFemaleHumansLabor, InducedParityPregnancyPregnancy, TwinPremature BirthUnited Statescesarean delivery rateRobson classificationUSAweighted adverse outcome score

Identifiers

PMID30082355
PMCPMC6078266

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