Abstract：
To examine the impact of the American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine (ACOG-SMFM) 2014 recommendations for preventing unnecessary primary Cesareans.
In a population-based cohort of births in New York City from 2012 to 2016, we used controlled interrupted time series analyses to estimate changes in age-standardized Cesarean rates among nulliparous, term, singleton vertex (NTSV) deliveries.
Among 192,405 NTSV births across 40 hospitals, the age-standardized NTSV Cesarean rate decreased after the ACOG-SMFM recommendations from 25.8% to 24.0% (Risk ratio [RR]: 0.93; 95% CI 0.89, 0.97), with no change in the control series. Decreases were observed among non-Hispanic White women (RR: 0.89; 95% CI 0.82, 0.97), but not among non-Hispanic Black women (RR: 0.97; 95% CI 0.88, 1.07), Asian/Pacific Islanders (RR: 1.01; 95% CI 0.91, 1.12), or Hispanic women (RR: 0.94; 95% CI 0.86, 1.02). Similar patterns were observed at teaching hospitals, with no change at nonteaching hospitals.
While low-risk Cesarean rates may be modifiable through changes in labor management, additional research, and interventions to address Cesarean disparities, are needed.
In a population-based cohort of births in New York City from 2012 to 2016, we used controlled interrupted time series analyses to estimate changes in age-standardized Cesarean rates among nulliparous, term, singleton vertex (NTSV) deliveries.
Among 192,405 NTSV births across 40 hospitals, the age-standardized NTSV Cesarean rate decreased after the ACOG-SMFM recommendations from 25.8% to 24.0% (Risk ratio [RR]: 0.93; 95% CI 0.89, 0.97), with no change in the control series. Decreases were observed among non-Hispanic White women (RR: 0.89; 95% CI 0.82, 0.97), but not among non-Hispanic Black women (RR: 0.97; 95% CI 0.88, 1.07), Asian/Pacific Islanders (RR: 1.01; 95% CI 0.91, 1.12), or Hispanic women (RR: 0.94; 95% CI 0.86, 1.02). Similar patterns were observed at teaching hospitals, with no change at nonteaching hospitals.
While low-risk Cesarean rates may be modifiable through changes in labor management, additional research, and interventions to address Cesarean disparities, are needed.
摘要：
目的：研究美国妇产科医师学会和母胎医学学会（ACOG-SMFM）2014年预防不必要的初级剖腹产的建议的影响。
方法：在2012-2016年纽约市以人口为基础的出生队列中，我们使用受控中断时间序列分析来估计未产者中年龄标准化剖宫产率的变化，term,单例顶点(NTSV)交付。
结果：在40家医院的192,405例NTSV出生中，ACOG-SMFM建议后，年龄标准化的NTSV剖宫产率从25.8％下降至24.0％（风险比[RR]：0.93；95％CI0.89，0.97），在控制系列中没有变化。在非西班牙裔白人女性中观察到下降（RR：0.89;95％CI0.82，0.97），但非西班牙裔黑人女性中没有(RR：0.97；95%CI0.88，1.07)，亚洲/太平洋岛民（RR：1.01；95%CI0.91，1.12），或西班牙裔女性（RR：0.94；95%CI0.86，1.02）。在教学医院观察到类似的模式，在非教学医院没有变化。
结论：虽然低风险剖宫产率可以通过改变分娩管理来改变，需要更多的研究和干预措施来解决剖宫产差异问题.
方法：在2012-2016年纽约市以人口为基础的出生队列中，我们使用受控中断时间序列分析来估计未产者中年龄标准化剖宫产率的变化，term,单例顶点(NTSV)交付。
结果：在40家医院的192,405例NTSV出生中，ACOG-SMFM建议后，年龄标准化的NTSV剖宫产率从25.8％下降至24.0％（风险比[RR]：0.93；95％CI0.89，0.97），在控制系列中没有变化。在非西班牙裔白人女性中观察到下降（RR：0.89;95％CI0.82，0.97），但非西班牙裔黑人女性中没有(RR：0.97；95%CI0.88，1.07)，亚洲/太平洋岛民（RR：1.01；95%CI0.91，1.12），或西班牙裔女性（RR：0.94；95%CI0.86，1.02）。在教学医院观察到类似的模式，在非教学医院没有变化。
结论：虽然低风险剖宫产率可以通过改变分娩管理来改变，需要更多的研究和干预措施来解决剖宫产差异问题.
