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dc.contributor.authorDelnord, Marieen_US
dc.contributor.authorBlondel, Béatriceen_US
dc.contributor.authorDrewniak, Nicolasen_US
dc.contributor.authorKlungsøyr, Karien_US
dc.contributor.authorBolumar, Franciscoen_US
dc.contributor.authorMohangoo, Ashnaen_US
dc.contributor.authorGissler, Mikaen_US
dc.contributor.authorSzamotulska, Katarzynaen_US
dc.contributor.authorLack, Nicholasen_US
dc.contributor.authorNijhuis, Janen_US
dc.contributor.authorVelebil, Petren_US
dc.contributor.authorSakkeus, Luuleen_US
dc.contributor.authorChalmers, Jamesen_US
dc.contributor.authorZeitlin, Jenniferen_US
dc.contributor.authorEuro-Peristat Preterm Groupen_US
dc.description.abstractBackground: While international variations in overall cesarean delivery rates are well documented, less information is available for clinical sub-groups. Cesarean data presented by subgroups can be used to evaluate uptake of cesarean reduction policies or to monitor delivery practices for high and low risk pregnancies based on new scientific evidence. We studied differences and patterns in cesarean delivery rates by multiplicity and gestational age in Europe and the United States. Methods: This study used routine aggregate data from 17 European countries and the United States on the number of singleton and multiple live births with cesarean versus vaginal delivery by week of gestation in 2008. Overall and gestation-specific cesarean delivery rates were analyzed. We computed rate differences to compare mode of delivery (cesarean vs vaginal birth) between selected gestational age groups and studied associations between rates in these subgroups namely: very preterm (26–31 weeks GA), moderate preterm (32–36 weeks GA), near term (37–38 weeks GA), term (39–41 weeks GA) and post-term (42+ weeks GA) births, using Spearman’s rank tests. Results: High variations in cesarean rates for singletons and multiples were observed everywhere. Rates for singletons varied from 15% in The Netherlands and Slovenia, to over 30% in the US and Germany. In singletons, rates were highest for very preterm births and declined to a nadir at 40 weeks of gestation, ranging from 8.0% in Sweden and Norway, to 22.5% in the US. These patterns differed across countries; the average rate difference between very preterm and term births was 43 percentage points, but ranged from 14% to 61%. High variations in rate differences were also observed for near term versus term births. For multiples, rates declined by gestational age in some countries, whereas in others rates were similar across all weeks of gestation. Countries’ overall cesarean rates were highly correlated with gestation-specific subgroup rates, except for very preterm births. Conclusions: Gestational age patterns in cesarean delivery were heterogeneous across countries; these differences highlight areas where consensus on best practices is lacking and could be used in developing strategies to reduce cesareans.en_US
dc.publisherBioMed Centraleng
dc.rightsAttribution CC BYeng
dc.subjectCesarean delivery (CD)eng
dc.subjectCross-national comparisonseng
dc.subjectGestational ageeng
dc.subjectPlurality, Mode of deliveryeng
dc.titleVarying gestational age patterns in cesarean delivery: an international comparisonen_US
dc.typePeer reviewed
dc.typeJournal article
dc.rights.holderCopyright 2014 Delnord et al.; licensee BioMed Central Ltd.
dc.rights.holderMarie Delnord et al.; licensee BioMed Central Ltd.
dc.source.journalBMC Pregnancy and Childbirth

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