Interinstitutional Variation of Caesarean Delivery Rates According to Indications in Selected Obstetric Populations: A Prospective Multicenter Study

• Main Authors: Gianpaolo Maso, Monica Piccoli, Marcella Montico, Lorenzo Monasta, Luca Ronfani, Sara Parolin, Carmine Gigli, Daniele Domini, Claudio Fiscella, Sara Casarsa, Carlo Zompicchiatti, Michela De Agostini, Attilio D’Atri, Raffaela Mugittu, Santo La Valle, Cristina Di Leonardo, Valter Adamo, Mara Fracas, Giovanni Del Frate, Monica Olivuzzi, Silvio Giove, Maria Parente, Daniele Bassini, Simona Melazzini, Secondo Guaschino, Caterina Businelli, Franco G. Toffoletti, Diego Marchesoni, Alberto Rossi, Sergio Demarini, Laura Travan, Giorgio Simon, Sandro Zicari, Giorgio Tamburlini, Salvatore Alberico
• Format: Article
• Language: English
• Published: Hindawi Limited 2013-01-01
• Series: BioMed Research International
• Online Access: http://dx.doi.org/10.1155/2013/786563

The aim of the study was to identify which groups of women contribute to interinstitutional variation of caesarean delivery (CD) rates and which are the reasons for this variation. In this regard, 15,726 deliveries from 11 regional centers were evaluated using the 10-group classification system. Standardized indications for CD in each group were used. Spearman’s correlation coefficient was used to calculate (1) relationship between institutional CD rates and relative sizes/CD rates in each of the ten groups/centers; (2) correlation between institutional CD rates and indications for CD in each of the ten groups/centers. Overall CD rates correlated with both CD rates in spontaneous and induced labouring nulliparous women with a single cephalic pregnancy at term (P=0.005). Variation of CD rates was also dependent on relative size and CD rates in multiparous women with previous CD, single cephalic pregnancy at term (P<0.001). As for the indications, “cardiotocographic anomalies” and “failure to progress” in the group of nulliparous women in spontaneous labour and “one previous CD” in multiparous women previous CD correlated significantly with institutional CD rates (P=0.021, P=0.005, and P<0.001, resp.). These results supported the conclusion that only selected indications in specific obstetric groups accounted for interinstitutional variation of CD rates.