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Green June-Risk Factors for Cesarean Delivery Among Puerto Rican Women From: Efrain Ramirez (eramirezt@coqui.net) Fri Jun 1 16:32:55 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr Eberhard Lisse: "Re: 'nuther one" Previous message: Henry Gregor: "Re: 'nuther one" Interesting...but preliminary "Because this analysis is based on data from birth certificates, it should be considered in the context of several limitations. Certain information on birth certificates may be underreported.12 However, past research has shown that percent agreement with medical record data for most characteristics examined in this analysis is relatively high.12–14 Sensitivity and positive predictive value for individual labor or medical complications are generally low, but specificity and negative predictive values for these factors are generally greater than 97%,12,15 and trends in these items are consistent over time. We were unable to examine certain factors not reported on birth certificates, such as reason for cesarean delivery, type of hospital, or type of insurance coverage, that may influence rates of cesarean delivery. Finally, no distinction could be made between cesarean deliveries that were elective, those that resulted from medical indications, and those that were conducted as emergency procedures, a concern highlighted by other researchers and public health practitioners.16 The dramatic rise in rates of primary cesarean deliveries in Puerto Rico was explained only partially by changes in demographic characteristics between 1996 and 2002. Additionally, in 2002 rates of primary cesarean delivery were lower among Puerto Rican women delivering on the mainland compared with women who delivered in Puerto Rico. Hypothesisgenerating research, such as key-informant interviews and focus groups, with obstetricians, hospital administrators, women of reproductive age, and other stakeholders may shed more light on the reasons behind the dramatic rise in rates over time in Puerto Rico and difference in rates between Puerto Rico and the mainland." -------------------------------------------------------------------------------- ORIGINAL RESEARCH -------------------------------------------------------------------------------- -- -------------------------------------------------------------------------------- Risk Factors for Cesarean Delivery Among Puerto Rican Women Sherry L. Farr, PhD1, Denise J. Jamieson, MD, MPH1, Hirmice Vásquez Rivera, MD2, Yusuf Ahmed, BM1 and Charles M. Heilig, PhD3 >From the 1Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; 2Maternal and Child Health Division, Puerto Rico Department of Health, San Juan, Puerto Rico; and 3Office of the Chief Science Officer, Centers for Disease Control and Prevention, Atlanta, Georgia. OBJECTIVE: The rate of primary cesarean delivery in Puerto Rico in 2002 was 52% higher than in 1996 and 85% higher than among Puerto Rican women delivering on the U.S. mainland. Reasons for these differences were explored using birth certificate data. METHODS: Distributions of mothers' age, education, parity, level of prenatal care, pregnancy weight gain, medical risk factors, labor induction, labor or delivery complications, and infant birth weight among births in Puerto Rico in 2002 (n@,489) were compared with births in Puerto Rico in 1996 (nQ,357) and births to Puerto Rican women delivering on the mainland in 2002 (nG,800). Multivariable log-linear regression models were used to estimate relative risks for primary cesarean delivery by year, place of delivery, and selected risk factors. RESULTS: Risk for cesarean delivery was higher in Puerto Rico in 2002 than in both 1996 (relative risk 2.1, 95% confidence interval 2.0, 2.3) and on the mainland in 2002 (relative risk 2.4, 95% confidence interval 2.2, 2.6). This translates into one additional cesarean delivery in Puerto Rico in 2002 for every 4.2 live births, controlled for examined risk factors. Higher rates of cesarean delivery in Puerto Rico in 2002 could not be explained by examined risk factors. CONCLUSION: Until further research reveals ways to safely reduce the rate of cesarean delivery in Puerto Rico, physicians, public health practitioners, and other stakeholders may want to focus their efforts on reducing rates among low-risk women and those with no labor complications. LEVEL OF EVIDENCE: II -- “ The greatest obstacle to knowledge is not ignorance, it is the illusion of knowledge.” Daniel J. Boorstin - Historian Next message: Dr Eberhard Lisse: "Re: 'nuther one" Previous message: Henry Gregor: "Re: 'nuther one"

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