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首页> 外文期刊>Journal of women’s health >What Are Optimal Cesarean Section Rates in the US and How Do We Get There? A Review of Evidence-Based Recommendations and Interventions
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What Are Optimal Cesarean Section Rates in the US and How Do We Get There? A Review of Evidence-Based Recommendations and Interventions

机译：我们在美国的最佳剖宫产率是什么以及我们如何到达那里？ 审查循证建议和干预措施

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摘要

Cesarean sections (CSs) are the most commonly performed surgical procedures in the world today. Global epidemiological studies from the last decade suggest that the optimal CS rates in developed countries exist somewhere between 15% and 19%. Despite these findings, CS rates in the United States have remained stable at slightly over 32% over the past 10 years. Using primary and secondary literature published from 2010 to 2015, this review discusses how optimal CS rates were developed. In addition, we define a category of potentially avoidable CS (i.e., those conducted on nulliparous low-risk women who present with vertex infants at term) and explore how CS in this population appear to be one of the main drivers of high CS rates overall. The institutional, provider, and patient-related factors, which may be related to higher-than-recommended rates of CS, particularly those conducted in low-risk women, will be discussed. This review will then delve into clinician and patient-oriented interventions that have been shown to effectively reduce the rate of potentially avoidable CS. Our analysis showed that large-scale, multifaceted interventions that include audit and feedback cycles as well as peer review strategies were the most effective in decreasing rates of potentially avoidable CS. This review concludes with an agenda for future research into interventions that aim to achieve optimal CS rates.
机译：剖腹产是当今世界上最常见的外科手术。过去十年的全球流行病学研究表明，发达国家的最佳CS发病率在15%到19%之间。尽管有这些发现，美国的CS发病率在过去10年中保持稳定，略高于32%。利用2010年至2015年发表的主要和次要文献，本综述讨论了如何制定最佳CS率。此外，我们定义了一类潜在可避免的CS（即，对足月有vertex婴儿的未产妇低风险妇女进行的研究），并探讨了该人群中的CS如何成为总体高CS率的主要驱动因素之一。将讨论机构、提供者和患者相关因素，这些因素可能与高于推荐的CS率有关，尤其是在低风险女性中进行的CS率。这篇综述将深入研究临床医生和患者导向的干预措施，这些干预措施已被证明能有效降低潜在可避免的CS的发生率。我们的分析表明，包括审计和反馈周期以及同行审查策略在内的大规模、多方面干预措施在降低潜在可避免的CS发病率方面最为有效。本综述总结了旨在实现最佳CS率的干预措施的未来研究议程。

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