The effect of change in a labour management protocol on caesarean section rate in nulliparous women

S.M. Kuppens, A. Brugman, T.H. Hasaart, E.K. Hutton, V.J.M. Pop

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Objective
To investigate the impact on obstetric outcome in nulliparous women of changing labour management from an expectant approach to proactive support of labour.
Methods
We conducted a retrospective cohort study in a teaching hospital in the Netherlands among 858 women ≥ 37 weeks’ gestation with a singleton fetus in cephalic position and spontaneous labour who planned to have a vaginal birth in the hospital under the care of an obstetrician. Exclusion criteria were gestational age < 37 weeks, induction of labour, primary Caesarean section, non-cephalic position, and non-Caucasian ethnicity. Labour outcomes in the period 1999 to 2002 (using an expectant approach) were compared with labour outcomes in the period 2008 to 2010 (using proactive support of labour). The primary outcome measure was the relationship between the CS rate and the form of labour management (expectant approach vs. proactive support). The secondary outcome measure was to identify risk factors for repeat CS.
Results
The overall prevalence of CS in the study population was 12.2%. The CS rate increased significantly from 9.7% between 1999 and 2002, to 15.4% between 2008 and 2010 (P < 0.001). Meanwhile, the assisted vaginal delivery rate decreased from 22.7% to 16.7% (P = 0.03).Multiple logistic regression showed that epidural analgesia (OR 4.6; 95% CI 2.6 to 8.4), occiput posterior position (OR 7.4; 95% CI 4.3 to 12.8), and advanced maternal age (OR 1.91; 95% 1.31 to 2.76) were risk factors for CS.
Conclusion
Changing labour management from an expectant approach to proactive support of labour did not decrease the Caesarean section rate.
Original languageEnglish
Pages (from-to)508-514
JournalJournal of Obstetrics and Gynaecology Canada
Volume35
Issue number6
DOIs
Publication statusPublished - 2013

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Induced Labor
Epidural Analgesia
Maternal Age
Teaching Hospitals
Netherlands
Gestational Age
Obstetrics
Fetus
Logistic Models

Cite this

@article{efbe4374bb5f4b068f66df5ca19a419b,
title = "The effect of change in a labour management protocol on caesarean section rate in nulliparous women",
abstract = "ObjectiveTo investigate the impact on obstetric outcome in nulliparous women of changing labour management from an expectant approach to proactive support of labour.MethodsWe conducted a retrospective cohort study in a teaching hospital in the Netherlands among 858 women ≥ 37 weeks’ gestation with a singleton fetus in cephalic position and spontaneous labour who planned to have a vaginal birth in the hospital under the care of an obstetrician. Exclusion criteria were gestational age < 37 weeks, induction of labour, primary Caesarean section, non-cephalic position, and non-Caucasian ethnicity. Labour outcomes in the period 1999 to 2002 (using an expectant approach) were compared with labour outcomes in the period 2008 to 2010 (using proactive support of labour). The primary outcome measure was the relationship between the CS rate and the form of labour management (expectant approach vs. proactive support). The secondary outcome measure was to identify risk factors for repeat CS.ResultsThe overall prevalence of CS in the study population was 12.2{\%}. The CS rate increased significantly from 9.7{\%} between 1999 and 2002, to 15.4{\%} between 2008 and 2010 (P < 0.001). Meanwhile, the assisted vaginal delivery rate decreased from 22.7{\%} to 16.7{\%} (P = 0.03).Multiple logistic regression showed that epidural analgesia (OR 4.6; 95{\%} CI 2.6 to 8.4), occiput posterior position (OR 7.4; 95{\%} CI 4.3 to 12.8), and advanced maternal age (OR 1.91; 95{\%} 1.31 to 2.76) were risk factors for CS.ConclusionChanging labour management from an expectant approach to proactive support of labour did not decrease the Caesarean section rate.",
author = "S.M. Kuppens and A. Brugman and T.H. Hasaart and E.K. Hutton and V.J.M. Pop",
year = "2013",
doi = "10.1016/S1701-2163(15)30908-7",
language = "English",
volume = "35",
pages = "508--514",
journal = "Journal of Obstetrics and Gynaecology Canada",
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}

The effect of change in a labour management protocol on caesarean section rate in nulliparous women. / Kuppens, S.M.; Brugman, A.; Hasaart, T.H.; Hutton, E.K.; Pop, V.J.M.

In: Journal of Obstetrics and Gynaecology Canada, Vol. 35, No. 6, 2013, p. 508-514.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - The effect of change in a labour management protocol on caesarean section rate in nulliparous women

AU - Kuppens, S.M.

AU - Brugman, A.

AU - Hasaart, T.H.

AU - Hutton, E.K.

AU - Pop, V.J.M.

PY - 2013

Y1 - 2013

N2 - ObjectiveTo investigate the impact on obstetric outcome in nulliparous women of changing labour management from an expectant approach to proactive support of labour.MethodsWe conducted a retrospective cohort study in a teaching hospital in the Netherlands among 858 women ≥ 37 weeks’ gestation with a singleton fetus in cephalic position and spontaneous labour who planned to have a vaginal birth in the hospital under the care of an obstetrician. Exclusion criteria were gestational age < 37 weeks, induction of labour, primary Caesarean section, non-cephalic position, and non-Caucasian ethnicity. Labour outcomes in the period 1999 to 2002 (using an expectant approach) were compared with labour outcomes in the period 2008 to 2010 (using proactive support of labour). The primary outcome measure was the relationship between the CS rate and the form of labour management (expectant approach vs. proactive support). The secondary outcome measure was to identify risk factors for repeat CS.ResultsThe overall prevalence of CS in the study population was 12.2%. The CS rate increased significantly from 9.7% between 1999 and 2002, to 15.4% between 2008 and 2010 (P < 0.001). Meanwhile, the assisted vaginal delivery rate decreased from 22.7% to 16.7% (P = 0.03).Multiple logistic regression showed that epidural analgesia (OR 4.6; 95% CI 2.6 to 8.4), occiput posterior position (OR 7.4; 95% CI 4.3 to 12.8), and advanced maternal age (OR 1.91; 95% 1.31 to 2.76) were risk factors for CS.ConclusionChanging labour management from an expectant approach to proactive support of labour did not decrease the Caesarean section rate.

AB - ObjectiveTo investigate the impact on obstetric outcome in nulliparous women of changing labour management from an expectant approach to proactive support of labour.MethodsWe conducted a retrospective cohort study in a teaching hospital in the Netherlands among 858 women ≥ 37 weeks’ gestation with a singleton fetus in cephalic position and spontaneous labour who planned to have a vaginal birth in the hospital under the care of an obstetrician. Exclusion criteria were gestational age < 37 weeks, induction of labour, primary Caesarean section, non-cephalic position, and non-Caucasian ethnicity. Labour outcomes in the period 1999 to 2002 (using an expectant approach) were compared with labour outcomes in the period 2008 to 2010 (using proactive support of labour). The primary outcome measure was the relationship between the CS rate and the form of labour management (expectant approach vs. proactive support). The secondary outcome measure was to identify risk factors for repeat CS.ResultsThe overall prevalence of CS in the study population was 12.2%. The CS rate increased significantly from 9.7% between 1999 and 2002, to 15.4% between 2008 and 2010 (P < 0.001). Meanwhile, the assisted vaginal delivery rate decreased from 22.7% to 16.7% (P = 0.03).Multiple logistic regression showed that epidural analgesia (OR 4.6; 95% CI 2.6 to 8.4), occiput posterior position (OR 7.4; 95% CI 4.3 to 12.8), and advanced maternal age (OR 1.91; 95% 1.31 to 2.76) were risk factors for CS.ConclusionChanging labour management from an expectant approach to proactive support of labour did not decrease the Caesarean section rate.

U2 - 10.1016/S1701-2163(15)30908-7

DO - 10.1016/S1701-2163(15)30908-7

M3 - Article

VL - 35

SP - 508

EP - 514

JO - Journal of Obstetrics and Gynaecology Canada

JF - Journal of Obstetrics and Gynaecology Canada

SN - 1701-2163

IS - 6

ER -