{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T03:18:21Z","timestamp":1768187901199,"version":"3.49.0"},"reference-count":25,"publisher":"CSIRO Publishing","issue":"1","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":3582,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,1,28]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To explore variation in public hospital rates of early (37\u221238 weeks gestation) prelabour repeat caesarean section among low-risk women at and beyond term in New South Wales (NSW) between 2008 and 2011.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Importance of the study:<\/jats:title>\n                    <jats:p>A NSW Ministry of Health policy directive for public hospitals (PD2007_024), \u2018Maternity \u2212 timing of elective or pre-labour caesarean section\u2019, requires that low-risk elective or prelabour caesarean section does not occur before 39 completed weeks gestation. However, compliance with this policy has not been evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study type:<\/jats:title>\n                    <jats:p>Population-based record linkage study<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Linked birth and hospital data for low-risk, prelabour repeat caesarean sections in NSW in 2008\u22122011 were analysed using multilevel regression modelling. Rates were adjusted for casemix and hospital factors. Low-risk pregnancies were defined as singleton live births at 37\u221242 weeks gestation among women without medical or obstetric complications and where the indication for caesarean section was \u2018elective repeat caesarean section\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In 2008\u22122011, there were 15 163 prelabour repeat caesarean sections among low-risk women in NSW. Overall, 34.7% of low-risk prelabour repeat caesarean sections occurred before 39 weeks gestation. Adjusted NSW public hospital rates of early (37\u221238 weeks gestation) low-risk prelabour repeat caesarean section varied widely (16.3\u221267.5%). Adjusting for casemix factors actually increased the between-hospital variation by 4.3%; adjusting for hospital factors reduced variation by 20.0%. Smoking, private healthcare, assisted reproductive technology use, higher parity, a noncaesarean uterine scar and delivering in a hospital with CPAP (continuous positive airway pressure) facilities were associated with higher odds of early delivery, although infants that were small for gestational age were associated with lower odds. Hospitals with higher rates of low-risk deliveries and higher propensity for vaginal birth after caesarean section had lower odds of early delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The findings suggest generally poor compliance with the policy directive that prelabour caesarean does not occur before 39 weeks gestation, with adjusted \u2212ompliance rates ranging from 32.5% to 83.7%. Large between-hospital variation after adjustment suggests that nonmedical factors are related to timing of low-risk prelabour repeat caesarean sections. Further strategies are needed to improve adherence to this evidence based policy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.17061\/phrp2611608","type":"journal-article","created":{"date-parts":[[2016,1,27]],"date-time":"2016-01-27T18:03:21Z","timestamp":1453917801000},"source":"Crossref","is-referenced-by-count":6,"title":["Variation in and factors associated with timing of low risk, pre-labour repeat caesarean sections in NSW, 2008-2011"],"prefix":"10.1071","volume":"26","author":[{"given":"Kathrin","family":"Schemann","sequence":"first","affiliation":[{"name":"A Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, NSW, Australia"},{"name":"B Biostatistics Training Program, NSW Ministry of Health, Sydney, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jillian","family":"Patterson","sequence":"additional","affiliation":[{"name":"A Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanya","family":"Nippita","sequence":"additional","affiliation":[{"name":"A Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, NSW, Australia"},{"name":"C Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Ford","sequence":"additional","affiliation":[{"name":"A Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah","family":"Matha","sequence":"additional","affiliation":[{"name":"D Maternal and Newborn Unit, Office of Kids and Families, NSW, Sydney, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Roberts","sequence":"additional","affiliation":[{"name":"A Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"67","published-online":{"date-parts":[[2016,1,28]]},"reference":[{"key":"2026011119364429200_R1","doi-asserted-by":"crossref","unstructured":"American College of Obstetricians and Gynecologists. ACOG committee opinion no. 561: nonmedically indicated early-term deliveries. Obstet Gynecol. 2013;121(4):911\u22125. CrossRef | PubMed","DOI":"10.1097\/01.AOG.0000428649.57622.a7"},{"key":"2026011119364429200_R2","unstructured":"Royal Australian and New Zealand College of Obsetricians and Gynaecologists. Timing of elective caesarean section at term. Sydney: RANZCOG; 2014 [cited 2015 Oct 15]. Available from: www.ranzcog.edu.au\/doc\/timing-of-elective-cs-at-term.html"},{"key":"2026011119364429200_R3","unstructured":"National Institute for Health and Clinical Excellence. Caesarean section: NICE guidelines [CG132]. Manchester: NICE; 2011 [cited 2015 Oct 15]. Available from: www.nice.org.uk\/guidance\/cg132"},{"key":"2026011119364429200_R4","doi-asserted-by":"crossref","unstructured":"Morris JM, Algert CS, Falster MO, Ford JB, Kinnear A, Nicholl MC, Roberts CL. Trends in planned early birth: a population-based study. Am J Obstet Gynecol. 2012;207(3):186.e1\u22128. CrossRef | PubMed","DOI":"10.1016\/j.ajog.2012.06.082"},{"key":"2026011119364429200_R5","unstructured":"NSW Health. Maternity \u2212 timing of elective or pre-labour caesarean section. Sydney: NSW Health; 2007 [cited 2015 Oct 15]. Available from: www0.health.nsw.gov.au\/policies\/pd\/2007\/pdf\/PD2007_024.pdf"},{"key":"2026011119364429200_R6","doi-asserted-by":"crossref","unstructured":"Nassar N, Schiff M, Roberts CL. Trends in the distribution of gestational age and contribution of planned births in New South Wales, Australia. PLoS One. 2013;8(2):e56238. CrossRef | PubMed","DOI":"10.1371\/journal.pone.0056238"},{"key":"2026011119364429200_R7","unstructured":"Centre for Health Record Linkage. Sydney: NSW Ministry of Health. Quality assurance; 2011 [cited 2015 May 1]; [about 3 screens]. Available from: www.cherel.org.au\/quality-assurance"},{"key":"2026011119364429200_R8","doi-asserted-by":"crossref","unstructured":"Bentley JP, Ford JB, Taylor LK, Irvine KA, Roberts CL. Investigating linkage rates among probabilistically linked birth and hospitalization records. BMC Med Res Methodol. 2012;12:149. CrossRef | PubMed","DOI":"10.1186\/1471-2288-12-149"},{"key":"2026011119364429200_R9","doi-asserted-by":"crossref","unstructured":"Schemann K, Patterson JA, Nippita TA, Ford JB, Roberts CL. Variation in hospital caesarean section rates for women with at least one previous caesarean section: a population based cohort study. BMC Pregnancy Childbirth. 2015;15:179. CrossRef | PubMed","DOI":"10.1186\/s12884-015-0609-x"},{"key":"2026011119364429200_R10","doi-asserted-by":"crossref","unstructured":"Nippita TA, Schemann K, Roberts CL. Prevalence of noncaesarean uterine surgical scars in a maternity population. Aust N Z J Obstet Gynaecol. 2015 Jul 29. doi: 10.1111\/ajo.12357. [Epub ahead of print]. CrossRef","DOI":"10.1111\/ajo.12357"},{"key":"2026011119364429200_R11","doi-asserted-by":"crossref","unstructured":"Nippita TA, Lee YY, Patterson JA, Ford J, Morris JM, Nicholl MC, Roberts CL. Variation in hospital caesarean section rates and obstetric outcomes among nulliparae at term: a population-based cohort study. BJOG. 2015;122(5):702\u221211. CrossRef | PubMed","DOI":"10.1111\/1471-0528.13281"},{"key":"2026011119364429200_R12","doi-asserted-by":"crossref","unstructured":"Chen JS, Roberts CL, Simpson JM, Ford JB. Use of hospitalisation history (lookback) to determine prevalence of chronic diseases: impact on modelling of risk factors for haemorrhage in pregnancy. BMC Med Res Methodol. 2011;11:68. CrossRef | PubMed","DOI":"10.1186\/1471-2288-11-68"},{"key":"2026011119364429200_R13","doi-asserted-by":"crossref","unstructured":"Roberts CL, Bell JC, Ford JB, Morris JM. Monitoring the quality of maternity care: how well are labour and delivery events reported in population health data? Paediatr Perinat Epidemiol. 2009;23(2):144\u221252. CrossRef | PubMed","DOI":"10.1111\/j.1365-3016.2008.00980.x"},{"key":"2026011119364429200_R14","doi-asserted-by":"crossref","unstructured":"Taylor L, Pym M, Bajuk B, Sutton L, Travis S, Banks C. Part 8: validation study NSW midwives data collection 1998. N S W Public Health Bull. 2000;Suppl 11(1):97\u22129. Available from: www.phrp.com.au\/issues\/volume-11-issue-1\/part-8-validation-study-nsw-midwives-data-collection-1998\/","DOI":"10.1071\/NB00S11"},{"key":"2026011119364429200_R15","doi-asserted-by":"crossref","unstructured":"Tita AT, Landon MB, Spong CY, Lai Y, Leveno KJ, Varner MW, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med. 2009;360(2):111\u221220. CrossRef | PubMed","DOI":"10.1056\/NEJMoa0803267"},{"key":"2026011119364429200_R16","doi-asserted-by":"crossref","unstructured":"Doan E, Gibbons K, Tudehope D. The timing of elective caesarean deliveries and early neonatal outcomes in singleton infants born 37\u221241 weeks' gestation. Aust N Z J Obstet Gynaecol. 2014;54(4):340\u22127. CrossRef | PubMed","DOI":"10.1111\/ajo.12220"},{"key":"2026011119364429200_R17","doi-asserted-by":"crossref","unstructured":"Dunn S, Sprague AE, Fell DB, Dy J, Harrold J, Lamontagne B, Walker M. The use of a quality indicator to reduce elective repeat caesarean section for low-risk women before 39 weeks' gestation: the Eastern Ontario experience. J Obstet Gynaecol Can. 2013;35(4):306\u221216. CrossRef | PubMed","DOI":"10.1016\/S1701-2163(15)30957-9"},{"key":"2026011119364429200_R18","doi-asserted-by":"crossref","unstructured":"Gurol-Urganci I, Cromwell DA, Edozien LC, Onwere C, Mahmood TA, van der Meulen JH. The timing of elective caesarean delivery between 2000 and 2009 in England. BMC Pregnancy Childbirth. 2011;11:43. CrossRef | PubMed","DOI":"10.1186\/1471-2393-11-43"},{"key":"2026011119364429200_R19","doi-asserted-by":"crossref","unstructured":"Glavind J, Henriksen TB, Kindberg SF, Uldbjerg N. Randomised trial of planned caesarean section prior to versus after 39 weeks: unscheduled deliveries and facility logistics \u2212 a secondary analysis. PLoS One. 2013;8(12):e84744. CrossRef | PubMed","DOI":"10.1371\/journal.pone.0084744"},{"key":"2026011119364429200_R20","doi-asserted-by":"crossref","unstructured":"Kaimal AJ, Kuppermann M. Understanding risk, patient and provider preferences, and obstetrical decision making: approach to delivery after cesarean. Semin Perinatol. 2010;34(5):331\u22126. CrossRef | PubMed","DOI":"10.1053\/j.semperi.2010.05.006"},{"key":"2026011119364429200_R21","doi-asserted-by":"crossref","unstructured":"Roberts CL, Nicholl MC, Algert CS, Ford JB, Morris JM, Chen JS. Rate of spontaneous onset of labour before planned repeat caesarean section at term. BMC Pregnancy Childbirth. 2014;14:125. CrossRef | PubMed","DOI":"10.1186\/1471-2393-14-125"},{"key":"2026011119364429200_R22","doi-asserted-by":"crossref","unstructured":"Clark SL, Frye DR, Meyers JA, Belfort MA, Dildy GA, Kofford S, et al. Reduction in elective delivery at &lt;39 weeks of gestation: comparative effectiveness of 3 approaches to change and the impact on neonatal intensive care admission and stillbirth. Am J Obstet Gynecol. 2010;203(5):449.e1\u22126. CrossRef | PubMed","DOI":"10.1016\/j.ajog.2010.05.036"},{"key":"2026011119364429200_R23","unstructured":"The National Quality Forum. Perinatal care (PC) elective delivery. Washington, DC: National Quality Forum; 2011 [updated 2014 May 1] [cited 2015 Oct 15] [about 4 screens]. Available from: manual.jointcommission.org\/releases\/TJC2015A1\/MIF0166.html"},{"key":"2026011119364429200_R24","doi-asserted-by":"crossref","unstructured":"Oshiro BT, Kowalewski L, Sappenfield W, Alter CC, Bettegowda VR, Russell R, et al. A multistate quality improvement program to decrease elective deliveries before 39 weeks of gestation. Obstet Gynecol. 2013;121(5):1025\u221231. CrossRef | PubMed","DOI":"10.1097\/AOG.0b013e31828ca096"},{"key":"2026011119364429200_R25","doi-asserted-by":"crossref","unstructured":"Little SE, Robinson JN, Puopolo KM, Mukhopadhyay S, Wilkins-Haug LE, Acker DA, Zera CA. The effect of obstetric practice change to reduce early term delivery on perinatal outcome. J Perinatol. 2014 Mar;34(3):176\u221280. CrossRef | PubMed","DOI":"10.1038\/jp.2013.166"}],"container-title":["Public Health Research and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/connectsci.au\/pu\/article-pdf\/doi\/10.17061\/phrp2611608\/1821855\/pu19060.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/connectsci.au\/pu\/article-pdf\/doi\/10.17061\/phrp2611608\/1821855\/pu19060.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:36:52Z","timestamp":1768178212000},"score":1,"resource":{"primary":{"URL":"https:\/\/connectsci.au\/pu\/article\/26\/1\/e2611608\/265309\/Variation-in-and-factors-associated-with-timing-of"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,1,28]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2016,1,28]]}},"URL":"https:\/\/doi.org\/10.17061\/phrp2611608","relation":{},"ISSN":["2204-2091"],"issn-type":[{"value":"2204-2091","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,1,28]]},"article-number":"e2611608"}}