{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T21:29:10Z","timestamp":1770326950887,"version":"3.49.0"},"reference-count":30,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,7,11]],"date-time":"2018-07-11T00:00:00Z","timestamp":1531267200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2018,10]]},"abstract":"Abstract<\/jats:title>Introduction<\/jats:title>To improve understanding of rising cesarean section (CS<\/jats:styled-content>) rates in the UK<\/jats:styled-content>, this study assessed the relation between clinician thresholds for performing CS<\/jats:styled-content> for delayed labor progress or suspected fetal distress and corresponding CS<\/jats:styled-content> rates in Aberdeen, UK<\/jats:styled-content>.<\/jats:p><\/jats:sec>Material and methods<\/jats:title>Time\u2010trends analysis of term births from 1988 to 2012 in a population of nulliparous women (N = 53\u00a0745) in Aberdeen, UK<\/jats:styled-content>, using Chi\u2010square test for trend, and binary logistic regression. Data were obtained from the Aberdeen Maternity and Neonatal Databank.<\/jats:p><\/jats:sec>Results<\/jats:title>Unplanned CS<\/jats:styled-content> rates per quintile increased from 11.0% (1391\/12\u00a0686) to 21.1% (2383\/11\u00a0273) between 1988 and 2012, while planned CS<\/jats:styled-content> rates increased from 2.7% (338\/12\u00a0686) to 5.2% (591\/11\u00a0273). The median duration of labor before CS<\/jats:styled-content> for delayed progress per quintile decreased from 17.2 (IQR<\/jats:styled-content> 12.5\u201022.3) to 13.1 hours (9.6\u201016.9) before first stage CS<\/jats:styled-content> and from 17.1 (12.6\u201022.3) to 15.3 (11.5\u201019.1) hours before second stage CS<\/jats:styled-content> (P\u00a0<\/jats:italic><\u00a0<\/jats:italic>.001). The proportion of CS<\/jats:styled-content> for suspected fetal distress performed with evidence of fetal acidosis declined from 23.4% (98\/418) to 17.4% (106\/608) per quintile (P\u00a0<\/jats:italic><\u00a0<\/jats:italic>.01). Neonatal unit admission (adjusted OR<\/jats:styled-content> 1.99, 95% CI<\/jats:styled-content> 1.85\u20102.14) was more likely following unplanned CS<\/jats:styled-content> than vaginal births. Birth trauma was less likely following both unplanned (adjusted OR 0.48, 95% CI<\/jats:styled-content> 0.39\u20100.60) and planned (adjusted OR<\/jats:styled-content> 0.33, 95% CI<\/jats:styled-content> 0.18\u20100.63) CS<\/jats:styled-content>.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Increased CS<\/jats:styled-content> rates can be partly attributed to lowered clinical thresholds for intrapartum CS<\/jats:styled-content>. Higher CS<\/jats:styled-content> rates are associated with less birth trauma for the offspring.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13409","type":"journal-article","created":{"date-parts":[[2018,6,14]],"date-time":"2018-06-14T07:06:03Z","timestamp":1528959963000},"page":"1257-1266","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Intervention thresholds and cesarean section rates: A time\u2010trends analysis"],"prefix":"10.1111","volume":"97","author":[{"given":"Anna","family":"Rose","sequence":"first","affiliation":[{"name":"NHS Greater Glasgow and Clyde Glasgow UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0853-9724","authenticated-orcid":false,"given":"Edwin Amalraj","family":"Raja","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics University of Aberdeen Aberdeen UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2358-5860","authenticated-orcid":false,"given":"Sohinee","family":"Bhattacharya","sequence":"additional","affiliation":[{"name":"Obstetric Epidemiology University of Aberdeen Aberdeen UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6841-8601","authenticated-orcid":false,"given":"Mairead","family":"Black","sequence":"additional","affiliation":[{"name":"Obstetrics University of Aberdeen Aberdeen UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,7,11]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Information Services Division.Births in Scottish Hospitals.2014.https:\/\/files.digital.nhs.uk\/publicationimport\/pub16\/pub16725\/nhs-mate-eng-2013-14-tab-v1.xlsx. 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