PMID- 27561206
OWN - NLM
STAT- MEDLINE
DCOM- 20181213
LR  - 20220330
IS  - 1471-0528 (Electronic)
IS  - 1470-0328 (Linking)
VI  - 124
IP  - 11
DP  - 2017 Oct
TI  - Cervical dilation at time of caesarean delivery in nulliparous women: a 
      population-based cohort study.
PG  - 1753-1761
LID - 10.1111/1471-0528.14275 [doi]
AB  - OBJECTIVES: Our objective was to describe contemporary practice patterns in the 
      timing of caesarean delivery in relation to cervical dilation, overall and by 
      indication for caesarean. Our secondary objective was to examine how commonly 
      caesarean delivery was performed for labour dystocia at dilations below 4 cm or 
      without the use of oxytocin, overall and between hospitals. DESIGN: 
      Retrospective, population-based cohort study. SETTING: Ontario, Alberta, and 
      British Columbia, Canada, 2008-2012. POPULATION: Nulliparous women in labour who 
      delivered term singletons in cephalic position. METHODS: Histograms were used to 
      examine the distribution of cervical dilation at time of caesarean delivery, 
      overall and by indication for caesarean. Funnel plots were used to illustrate 
      variation in hospital-level rates of caesarean deliveries for labour dystocia 
      that were performed early (<4 cm dilation) or without the use of oxytocin. MAIN 
      OUTCOME MEASURES: Cervical dilation (in centimetres) at time of caesarean 
      delivery. RESULTS: The population-based cohort comprised 392 025 women, of whom 
      18.8% had a caesarean delivery. Of first-stage caesareans for labour dystocia in 
      women who entered labour spontaneously, 13.6% (95% CI 12.9, 14.2) had dilations 
      <4 cm [hospital-level inter-quartile range (IQR): 6.2% to 20.0%] and 29.5% (95% 
      CI 28.6, 30.4) did not receive oxytocin to treat their dystocia (hospital-level 
      IQR: 22.1-54.6%). CONCLUSIONS: The proportion of caesareans done before 4 cm 
      dilation or without oxytocin varies substantially across hospitals and suggests 
      the need for institutions to review their practices and ensure that management of 
      labour practice guidelines are followed. TWEETABLE ABSTRACT: Many caesareans for 
      labour dystocia are performed early during labour (<4 cm dilation) or without 
      oxytocin.
CI  - (c) 2016 Royal College of Obstetricians and Gynaecologists.
FAU - Riddell, C A
AU  - Riddell CA
AD  - Department of Epidemiology, Biostatistics, and Occupational Health, McGill 
      University, Montreal, QC, Canada.
FAU - Kaufman, J S
AU  - Kaufman JS
AD  - Department of Epidemiology, Biostatistics, and Occupational Health, McGill 
      University, Montreal, QC, Canada.
FAU - Strumpf, E C
AU  - Strumpf EC
AD  - Department of Epidemiology, Biostatistics, and Occupational Health, McGill 
      University, Montreal, QC, Canada.
AD  - Department of Economics, McGill University, Montreal, QC, Canada.
FAU - Abenhaim, H A
AU  - Abenhaim HA
AD  - Department of Obstetrics and Gynecology, Jewish General Hospital, McGill 
      University, Montreal, QC, Canada.
AD  - Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, 
      Montreal, QC, Canada.
FAU - Hutcheon, J A
AU  - Hutcheon JA
AD  - Department of Obstetrics and Gynaecology, University of British Columbia, 
      Vancouver, BC, Canada.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20160826
PL  - England
TA  - BJOG
JT  - BJOG : an international journal of obstetrics and gynaecology
JID - 100935741
RN  - 0 (Oxytocics)
SB  - IM
MH  - Adult
MH  - Canada/epidemiology
MH  - Cervix Uteri/*physiology
MH  - Cesarean Section/*statistics & numerical data
MH  - Dilatation
MH  - Dystocia/*physiopathology
MH  - Female
MH  - Guideline Adherence/*statistics & numerical data
MH  - Humans
MH  - Infant, Newborn
MH  - Labor Onset/*physiology
MH  - Oxytocics/therapeutic use
MH  - Parity
MH  - Practice Patterns, Physicians'/*statistics & numerical data
MH  - Pregnancy
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Caesarean delivery
OT  - cervical dilation
OT  - clinical guidelines
OT  - labour dystocia
EDAT- 2016/08/27 06:00
MHDA- 2018/12/14 06:00
CRDT- 2016/08/27 06:00
PHST- 2016/06/05 00:00 [accepted]
PHST- 2016/08/27 06:00 [pubmed]
PHST- 2018/12/14 06:00 [medline]
PHST- 2016/08/27 06:00 [entrez]
AID - 10.1111/1471-0528.14275 [doi]
PST - ppublish
SO  - BJOG. 2017 Oct;124(11):1753-1761. doi: 10.1111/1471-0528.14275. Epub 2016 Aug 26.