Factors Associated with the Recent Increasing Cesarean Delivery Rate at a Japanese Perinatal Center

Abstract

Objective. We examined which specific factors contributed to the increase in Cesarean delivery rate at our hospital over a 10-year period. Methods. From January 2002 to December 2012, data on the Japanese singleton deliveries at ≥22-week gestation managed at Japanese Red Cross Katsushika Maternity Hospital were collected. Potential factors associated with the increasing Cesarean delivery rate were selected according to previous studies. In this study, the incidences of intrauterine fetal demise, umbilical artery pH <7.1, and severe perineal laceration were calculated for each year. Results. The Cesarean delivery rate at our institution increased significantly during the study period (17.3% in 2002 versus 23.4% in 2012, P < 0.01). During the study period, the Cesarean delivery rates in the cases of nulliparity, preterm delivery, low birth weight (<2,500 g), previous Cesarean deliveries and breech presentation were increased significantly. The incidence of intrauterine fetal demise and low umbilical artery pH was significantly decreased, and a negative correlation was found between the Cesarean delivery rate and the incidence of low umbilical artery pH for each year (r = −0.92, P < 0.01). Conclusion. At our institute, the neonatal outcomes seemed to be improved associated with the increased Cesarean delivery rate between 2002 and 2012.

Effect of medical institution change on gestational duration after the Great East Japan Earthquake: The Fukushima Health Management Survey

“…Thus, the change of institution due to medical indication, particularly to tertiary medical institutions, might be associated with shortened gestational duration and preterm birth. In addition, our results were consistent with previous reports describing the association between cesarean section and preterm birth . Our sensitivity analysis using a multiple linear regression model excluding cesarean section cases showed similar results as found in our main analysis.…”

“…In addition, our results were consistent with previous reports describing the association between cesarean section and preterm birth. [12][13][14] Our sensitivity analysis using a multiple linear regression model excluding cesarean section cases showed similar results as found in our main analysis. Therefore, because there were no significant associations between institution change due to self-referral and gestational duration or preterm birth in the main and sensitivity analyses, it might be difficult to consider institution change due to self-referral as a risk factor for shortened gestational duration.…”

Obstetric Outcomes of Twin Pregnancies in Japanese Women Aged 40 and Older

“…In our earlier study, the rate of cesarean delivery in AMA women was higher than that in younger women [ 7 ]; however, in the current study, the difference in the rate of cesarean delivery did not reach statistical significance. This may be due to the recent dramatic increase in the overall cesarean delivery rate of twin pregnancies [ 14 , 15 ]. The increase has been supposed to be due to physician counseling and maternal request for elective cesarean delivery to avoid perinatal asphyxia especially in the second twin and/or combined vaginal-cesarean delivery [ 16 - 18 ].…”

Trends in mode of delivery for breech presentation in Japan: ‘Transverse figure 8 breech delivery’

“…In Japan, primary elective cesarean delivery rates for singleton breech pregnancies have markedly increased due to medical counseling and maternal requests associated with the American College of Obstetricians and Gynecologists (ACOG) recommendation in 2001, [1][2][3][4][5][6] which recommended planned cesarean delivery for term singleton breech. The recommendation was made based on the observation by Hannah et al 6) that perinatal and neonatal complication rates were significantly lower in the planned cesarean group relative to the planned vaginal delivery group.…”

“…7) In our institute (one of the major perinatal centers in Tokyo, Japan), the primary elective cesarean delivery rate for breech presentation based on informed consent increased from 59.0% (36/61 cases of singleton breech term deliveries) in 2000 to 76.8% (53/69 cases) in 2005 (P < 0.05 using χ 2 with Fisher exact test). 3) In 2012, Kubonoya et al 4) reviewed cases of breech presentation in obstetrical facilities that are members of the Tokyo Operation group from 1981 to 2010. The rate of breech presentation was 2.4% (64,528/2,672,409 women in labor).…”