{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:59:49Z","timestamp":1793145589969,"version":"4.5.0"},"reference-count":38,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,2,17]],"date-time":"2018-02-17T00:00:00Z","timestamp":1518825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Birth"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Rates of cesarean birth have continued to rise in many high\u2010income countries. We examined the temporal trends and predictors of cesarean birth in Singapore.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Linked hospitalization and Birth Registry data were used to examine all live births to Singaporean citizens and permanent residents between January 1, 2005 and December 31, 2014 (n\u00a0=\u00a0342\u00a0932 births). We calculated cesarean rates and age\u2010adjusted average annual percent change (<jats:styled-content style=\"fixed-case\">AAPC<\/jats:styled-content>) in those rates and used sequential multivariable regression modeling to assess the contribution of changes in predictors to the change in cesarean rates over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The overall cesarean rate in Singapore rose from 32.2% in 2005 to 37.4% in 2014. Among singleton, cephalic, term pregnancies, the two major predictions of cesarean were nulliparity and previous cesarean, each accounting for just over one\u2010third of all cesareans.<\/jats:p><jats:p>Higher <jats:styled-content style=\"fixed-case\">AAPC<\/jats:styled-content> was observed in nulliparous women of Indian ethnicity (0.74% [95% confidence interval 0.68\u20100.80]) compared with Chinese (0.62% [0.60\u20100.65]) or Malay women (0.63% [0.59\u20100.68]), and in women who delivered in private hospitals (0.62% [0.60\u20100.64]) compared with those delivered under subsidized care in public hospitals (0.58% [0.52\u20100.63]). Parity and education had the largest influences on cesarean birth trend (attenuation of <jats:styled-content style=\"fixed-case\">AAPC<\/jats:styled-content> from 0.62% [0.59\u20100.66] to 0.39% [0.38\u20100.40] after adjustment).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Cesarean birth has continued to rise at a steady rate in Singapore. Strategies to curb this temporal increase include avoidance of medically unnecessary primary cesarean and attempts at trial of labor and vaginal delivery among women with a history of prior cesarean.<\/jats:p><\/jats:sec>","DOI":"10.1111\/birt.12341","type":"journal-article","created":{"date-parts":[[2018,2,17]],"date-time":"2018-02-17T08:16:43Z","timestamp":1518855403000},"page":"399-408","source":"Crossref","is-referenced-by-count":11,"title":["Trends and predictors of cesarean birth in Singapore, 2005\u20102014: A population\u2010based cohort study"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1185-715X","authenticated-orcid":false,"given":"Claudia","family":"Chi","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Hospital  Singapore City Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deanette","family":"Pang","sequence":"additional","affiliation":[{"name":"Policy Research &amp; Evaluation Division Ministry of Health  Singapore City Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Izzuddin M.","family":"Aris","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Hospital  Singapore City Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei Ting","family":"Teo","sequence":"additional","affiliation":[{"name":"Policy Research &amp; Evaluation Division Ministry of Health  Singapore City Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah Weiling","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Hospital  Singapore City Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arijit","family":"Biswas","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Hospital  Singapore City Singapore"},{"name":"Obstetrics and Gynaecology, Yong Loo Lin School of Medicine National University of Singapore  Singapore City Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eu Leong","family":"Yong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Hospital  Singapore City Singapore"},{"name":"Obstetrics and Gynaecology, Yong Loo Lin School of Medicine National University of Singapore  Singapore City Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yap Seng","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology National University Hospital  Singapore City Singapore"},{"name":"Obstetrics and Gynaecology, Yong Loo Lin School of Medicine National University of Singapore  Singapore City Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelvin","family":"Tan","sequence":"additional","affiliation":[{"name":"Policy Research &amp; Evaluation Division Ministry of Health  Singapore City Singapore"},{"name":"Saw Swee Hock School of Public Health National University of Singapore  Singapore City Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Kramer","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Pediatrics and Epidemiology and Biostatistics McGill University  Montreal Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,2,17]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12129"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-536X.2007.00205.x"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000296658.83240.6d"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2008.07.003"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000219750.79480.84"},{"key":"e_1_2_5_7_1","first-page":"1","article-title":"The global numbers and costs of additionally needed and unnecessary cesarean sections performed per year: overuse as a barrier to universal coverage","volume":"30","author":"Gibbons L","year":"2010","journal-title":"World Health Report"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1071\/AH10919"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68704-7"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61870-5"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12153"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2006.07.002"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-789X.2008.00537.x"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0001-6349.2004.00506.x"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01307.x"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-11-8"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31821e5f65"},{"key":"e_1_2_5_18_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1515\/jpm-2012-0049","article-title":"To \u2018C\u2019 or not to \u2018C\u2019? 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