Survey of Mode of Delivery and Maternal and Perinatal Outcomes in Canada

Canadian Mode of Delivery Study Group

doi:10.1016/j.jogc.2022.04.017

Survey of Mode of Delivery and Maternal and Perinatal Outcomes in Canada

Canadian Mode of Delivery Study Group

Women & Children's Health

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Objective: To identify determinants of cesarean delivery (CD) and examine associations between mode of delivery (MOD) and maternal and perinatal outcomes. Methods: We conducted a retrospective analysis of a Canadian multicentre birth cohort derived from provincial data collected in 2008/2009. Maternal and perinatal characteristics and outcomes were compared between vaginal and cesarean birth and between the following MOD subgroups: spontaneous vaginal delivery (VD), assisted VD, planned cesarean delivery (CD), and intrapartum CD. Multivariate regression identified determinants of CD and the effects of MOD and previous CD on maternal and perinatal outcomes. Results: The cohort included 264 755 births (72.1% VD and 27.9% CD) from 91 participating institutions. Determinants of CD included maternal age, parity, previous CD, chronic hypertension, diabetes, urinary tract infection or pyelonephritis, gestational hypertension, vaginal bleeding, labour induction, pre-term gestational age, low birth weight, large for gestational age, malpresentation, and male sex. CD was associated with greater risk of maternal and perinatal morbidity and mortality. Subgroup analysis demonstrated higher risk of adverse pregnancy outcomes with assisted VD and intrapartum CD than spontaneous VD. Planned CD reduced the risk of obstetric wound hematoma and perinatal mortality but increased maternal and neonatal morbidity. Previous CD increased the risk of maternal and neonatal morbidity among multiparous women. Conclusions: The CD rate in Canada is consistent with global trends reflecting demographic and obstetric intervention factors. The risk of adverse pregnancy outcomes with CD warrants evaluation of interventions to safely prevent nonessential cesarean birth.

Original language	English
Pages (from-to)	960-971
Number of pages	12
Journal	Journal of Obstetrics and Gynaecology Canada
Volume	44
Issue number	9
DOIs	https://doi.org/10.1016/j.jogc.2022.04.017
Publication status	Published - Sept 2022

Keywords

cesarean section
delivery, obstetric
maternal outcomes
obstetrical forceps
pregnancy outcome
vacuum extraction, obstetrical

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jogc.2022.04.017

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@article{315736d3fe1941769aaa41ce7e154de4,

title = "Survey of Mode of Delivery and Maternal and Perinatal Outcomes in Canada",

abstract = "Objective: To identify determinants of cesarean delivery (CD) and examine associations between mode of delivery (MOD) and maternal and perinatal outcomes. Methods: We conducted a retrospective analysis of a Canadian multicentre birth cohort derived from provincial data collected in 2008/2009. Maternal and perinatal characteristics and outcomes were compared between vaginal and cesarean birth and between the following MOD subgroups: spontaneous vaginal delivery (VD), assisted VD, planned cesarean delivery (CD), and intrapartum CD. Multivariate regression identified determinants of CD and the effects of MOD and previous CD on maternal and perinatal outcomes. Results: The cohort included 264 755 births (72.1% VD and 27.9% CD) from 91 participating institutions. Determinants of CD included maternal age, parity, previous CD, chronic hypertension, diabetes, urinary tract infection or pyelonephritis, gestational hypertension, vaginal bleeding, labour induction, pre-term gestational age, low birth weight, large for gestational age, malpresentation, and male sex. CD was associated with greater risk of maternal and perinatal morbidity and mortality. Subgroup analysis demonstrated higher risk of adverse pregnancy outcomes with assisted VD and intrapartum CD than spontaneous VD. Planned CD reduced the risk of obstetric wound hematoma and perinatal mortality but increased maternal and neonatal morbidity. Previous CD increased the risk of maternal and neonatal morbidity among multiparous women. Conclusions: The CD rate in Canada is consistent with global trends reflecting demographic and obstetric intervention factors. The risk of adverse pregnancy outcomes with CD warrants evaluation of interventions to safely prevent nonessential cesarean birth.",

keywords = "cesarean section, delivery, obstetric, maternal outcomes, obstetrical forceps, pregnancy outcome, vacuum extraction, obstetrical",

author = "{Canadian Mode of Delivery Study Group} and Jie Yang and Armson, {B. Anthony} and Rebecca Attenborough and Carson, {George D.} and {da Silva}, Orlando and Maureen Heaman and Patricia Janssen and Murphy, {Phil A.} and Pasquier, {Jean Charles} and Reg Sauve and {Von Dadelszen}, Peter and Mark Walker and Lee, {Shoo K.} and John Andruschak and Sheryll Dale and Kenny Der and Terri Pacheco and Karen Vida and Corrine Frick and Nancy Bott and Carr, {Lee Ann} and Daniel Bedard and Nicole Robert and Ann Sprague and Maryse Berthiaume and Richard Beaudoin and John Fahey and Irene Gagnon and Phil Murphy and Victoria Allen and Alan Bocking and Jim Bottomley and Emmanuel Bujold and Karen Campbell and Jan Christilaw and Joan Crane and Linda Dodds and Allan Donner and Alexandre Dumont and Susie Dzakpasu and Abigail Forson and Bill Fraser and Anita Gagnon and Joseph, {K. S.} and Michael Klein and Michael Kramer and Martine LaFrance and Karine Lemay and Shiliang Liu and Moutquin, {Jean Marie}",

note = "Funding Information: Disclosures: Funding for this study was provided by a Canadian Institutes of Health Research Operating Grant of $500 000 CAD. Organizational support for the Canadian Mode of Delivery Study Group was provided by the Maternal-infant Care Research Centre at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by a Canadian Institutes of Health Research Team Grant (CTP 87518) and Mount Sinai Hospital. The study sponsors had no role in the study design; the collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the paper for publication. All authors confirm they had full access to all data in the study and accept responsibility to submit for publication. Funding Information: The authors thank the investigators and collaborators of the Canadian Mode of Delivery Study Group, including collaborators from the provincial perinatal programs in British Columbia, Alberta, Saskatchewan, Ontario, Qu{\'e}bec, Nova Scotia, and Newfoundland and Labrador and those from the World Health Organization. Lists of individual collaborators and their affiliations are presented. The authors thank Heather McDonald Kinkaid, PhD, a scientific writer at the Maternal-infant Care Research Centre at Mount Sinai Hospital in Toronto, Ontario, Canada, for editorial support in preparing this manuscript. They also thank Priscilla Chan, project coordinator, Eugene Yoon, statistician, and other MiCare staff for data management and organizational support. Dr. McDonald Kinkaid's, Priscilla Chan's, and Eugene Yoon's contributions were within the scopes of their employment at MiCare, for which they receive salaries. Canadian Mode of Delivery Study Group Collaborators and Affiliations, Provincial Perinatal Programs, Perinatal Services BC, Provincial Health Services Authority: John Andruschak; Sheryll Dale; Kenny Der; Terri Pacheco; Karen Vida, Alberta Perinatal Health Program: Corrine Frick; Nancy Bott, Regina Qu'Appelle Health Region: Lee-Ann Carr, Better Outcomes Registry & Network (“BORN”), part of the Children's Hospital of Eastern Ontario: Daniel Bedard; Nicole Robert; Ann Sprague, Commission d'acc{\`e}s {\`a} l'information du Qu{\'e}bec: Maryse Berthiaume; Richard Beaudoin, Reproductive Care Program of Nova Scotia: Rebecca Attenborough; John Fahey; Irene Gagnon, Newfoundland and Labrador Provincial Perinatal Program: Phil Murphy, Other Canadian Mode of Delivery Study Group Collaborators: Victoria Allen: Dalhousie University; Alan Bocking: University of Toronto; Jim Bottomley: Children's Hospital of Eastern Ontario; Emmanuel Bujold: Universit{\'e} Laval; Karen Campbell: University of Western Ontario; Jan Christilaw: University of British Columbia; Joan Crane: Memorial University; Linda Dodds: Dalhousie University; Allan Donner: University of Western Ontario; Alexandre Dumont: Universit{\'e} de Montr{\'e}al; Susie Dzakpasu: Public Health Agency of Canada; Abigail Forson: Canadian Institutes of Health Research; Bill Fraser: Universit{\'e} de Montr{\'e}al; Anita Gagnon: McGill University; KS Joseph: Dalhousie University; Michael Klein: University of British Columbia; Michael Kramer: Canadian Institutes of Health Research; Martine LaFrance: Canadian Institutes of Health Research; Karine Lemay: Canadian Institutes of Health Research; Shiliang Liu: Public Health Agency of Canada; Jean-Marie Moutquin: University of Sherbrooke; Carl Nimrod: University of Ottawa; Robert Platt: McGill University; Beverley O'Brien: University of Alberta; Arne Ohlsson: University of Toronto; Shi Wu Wen: University of Ottawa, World Health Organization: Metin Gulmezoghu; Archana Shah; Jose Villar Disclosures: Funding for this study was provided by a Canadian Institutes of Health Research Operating Grant of CAN $500 000. Organizational support for the Canadian Mode of Delivery Study Group was provided by the Maternal-infant Care Research Centre at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by a Canadian Institutes of Health Research Team Grant (CTP 87518) and Mount Sinai Hospital. The study sponsors had no role in the study design; the collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the paper for publication. All authors confirm they had full access to all data in the study and accept responsibility to submit for publication. Publisher Copyright: {\textcopyright} 2022 The Society of Obstetricians and Gynaecologists of Canada/La Soci{\'e}t{\'e} des obst{\'e}triciens et gyn{\'e}cologues du Canada",

year = "2022",

month = sep,

doi = "10.1016/j.jogc.2022.04.017",

language = "English",

volume = "44",

pages = "960--971",

journal = "Journal of Obstetrics and Gynaecology Canada",

issn = "1701-2163",

publisher = "Healthcare & Financial Pub.",

number = "9",

}

TY - JOUR

T1 - Survey of Mode of Delivery and Maternal and Perinatal Outcomes in Canada

AU - Canadian Mode of Delivery Study Group

AU - Yang, Jie

AU - Armson, B. Anthony

AU - Attenborough, Rebecca

AU - Carson, George D.

AU - da Silva, Orlando

AU - Heaman, Maureen

AU - Janssen, Patricia

AU - Murphy, Phil A.

AU - Pasquier, Jean Charles

AU - Sauve, Reg

AU - Von Dadelszen, Peter

AU - Walker, Mark

AU - Lee, Shoo K.

AU - Andruschak, John

AU - Dale, Sheryll

AU - Der, Kenny

AU - Pacheco, Terri

AU - Vida, Karen

AU - Frick, Corrine

AU - Bott, Nancy

AU - Carr, Lee Ann

AU - Bedard, Daniel

AU - Robert, Nicole

AU - Sprague, Ann

AU - Berthiaume, Maryse

AU - Beaudoin, Richard

AU - Fahey, John

AU - Gagnon, Irene

AU - Murphy, Phil

AU - Allen, Victoria

AU - Bocking, Alan

AU - Bottomley, Jim

AU - Bujold, Emmanuel

AU - Campbell, Karen

AU - Christilaw, Jan

AU - Crane, Joan

AU - Dodds, Linda

AU - Donner, Allan

AU - Dumont, Alexandre

AU - Dzakpasu, Susie

AU - Forson, Abigail

AU - Fraser, Bill

AU - Gagnon, Anita

AU - Joseph, K. S.

AU - Klein, Michael

AU - Kramer, Michael

AU - LaFrance, Martine

AU - Lemay, Karine

AU - Liu, Shiliang

AU - Moutquin, Jean Marie

N1 - Funding Information: Disclosures: Funding for this study was provided by a Canadian Institutes of Health Research Operating Grant of $500 000 CAD. Organizational support for the Canadian Mode of Delivery Study Group was provided by the Maternal-infant Care Research Centre at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by a Canadian Institutes of Health Research Team Grant (CTP 87518) and Mount Sinai Hospital. The study sponsors had no role in the study design; the collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the paper for publication. All authors confirm they had full access to all data in the study and accept responsibility to submit for publication. Funding Information: The authors thank the investigators and collaborators of the Canadian Mode of Delivery Study Group, including collaborators from the provincial perinatal programs in British Columbia, Alberta, Saskatchewan, Ontario, Québec, Nova Scotia, and Newfoundland and Labrador and those from the World Health Organization. Lists of individual collaborators and their affiliations are presented. The authors thank Heather McDonald Kinkaid, PhD, a scientific writer at the Maternal-infant Care Research Centre at Mount Sinai Hospital in Toronto, Ontario, Canada, for editorial support in preparing this manuscript. They also thank Priscilla Chan, project coordinator, Eugene Yoon, statistician, and other MiCare staff for data management and organizational support. Dr. McDonald Kinkaid's, Priscilla Chan's, and Eugene Yoon's contributions were within the scopes of their employment at MiCare, for which they receive salaries. Canadian Mode of Delivery Study Group Collaborators and Affiliations, Provincial Perinatal Programs, Perinatal Services BC, Provincial Health Services Authority: John Andruschak; Sheryll Dale; Kenny Der; Terri Pacheco; Karen Vida, Alberta Perinatal Health Program: Corrine Frick; Nancy Bott, Regina Qu'Appelle Health Region: Lee-Ann Carr, Better Outcomes Registry & Network (“BORN”), part of the Children's Hospital of Eastern Ontario: Daniel Bedard; Nicole Robert; Ann Sprague, Commission d'accès à l'information du Québec: Maryse Berthiaume; Richard Beaudoin, Reproductive Care Program of Nova Scotia: Rebecca Attenborough; John Fahey; Irene Gagnon, Newfoundland and Labrador Provincial Perinatal Program: Phil Murphy, Other Canadian Mode of Delivery Study Group Collaborators: Victoria Allen: Dalhousie University; Alan Bocking: University of Toronto; Jim Bottomley: Children's Hospital of Eastern Ontario; Emmanuel Bujold: Université Laval; Karen Campbell: University of Western Ontario; Jan Christilaw: University of British Columbia; Joan Crane: Memorial University; Linda Dodds: Dalhousie University; Allan Donner: University of Western Ontario; Alexandre Dumont: Université de Montréal; Susie Dzakpasu: Public Health Agency of Canada; Abigail Forson: Canadian Institutes of Health Research; Bill Fraser: Université de Montréal; Anita Gagnon: McGill University; KS Joseph: Dalhousie University; Michael Klein: University of British Columbia; Michael Kramer: Canadian Institutes of Health Research; Martine LaFrance: Canadian Institutes of Health Research; Karine Lemay: Canadian Institutes of Health Research; Shiliang Liu: Public Health Agency of Canada; Jean-Marie Moutquin: University of Sherbrooke; Carl Nimrod: University of Ottawa; Robert Platt: McGill University; Beverley O'Brien: University of Alberta; Arne Ohlsson: University of Toronto; Shi Wu Wen: University of Ottawa, World Health Organization: Metin Gulmezoghu; Archana Shah; Jose Villar Disclosures: Funding for this study was provided by a Canadian Institutes of Health Research Operating Grant of CAN $500 000. Organizational support for the Canadian Mode of Delivery Study Group was provided by the Maternal-infant Care Research Centre at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by a Canadian Institutes of Health Research Team Grant (CTP 87518) and Mount Sinai Hospital. The study sponsors had no role in the study design; the collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the paper for publication. All authors confirm they had full access to all data in the study and accept responsibility to submit for publication. Publisher Copyright: © 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada

PY - 2022/9

Y1 - 2022/9

N2 - Objective: To identify determinants of cesarean delivery (CD) and examine associations between mode of delivery (MOD) and maternal and perinatal outcomes. Methods: We conducted a retrospective analysis of a Canadian multicentre birth cohort derived from provincial data collected in 2008/2009. Maternal and perinatal characteristics and outcomes were compared between vaginal and cesarean birth and between the following MOD subgroups: spontaneous vaginal delivery (VD), assisted VD, planned cesarean delivery (CD), and intrapartum CD. Multivariate regression identified determinants of CD and the effects of MOD and previous CD on maternal and perinatal outcomes. Results: The cohort included 264 755 births (72.1% VD and 27.9% CD) from 91 participating institutions. Determinants of CD included maternal age, parity, previous CD, chronic hypertension, diabetes, urinary tract infection or pyelonephritis, gestational hypertension, vaginal bleeding, labour induction, pre-term gestational age, low birth weight, large for gestational age, malpresentation, and male sex. CD was associated with greater risk of maternal and perinatal morbidity and mortality. Subgroup analysis demonstrated higher risk of adverse pregnancy outcomes with assisted VD and intrapartum CD than spontaneous VD. Planned CD reduced the risk of obstetric wound hematoma and perinatal mortality but increased maternal and neonatal morbidity. Previous CD increased the risk of maternal and neonatal morbidity among multiparous women. Conclusions: The CD rate in Canada is consistent with global trends reflecting demographic and obstetric intervention factors. The risk of adverse pregnancy outcomes with CD warrants evaluation of interventions to safely prevent nonessential cesarean birth.

AB - Objective: To identify determinants of cesarean delivery (CD) and examine associations between mode of delivery (MOD) and maternal and perinatal outcomes. Methods: We conducted a retrospective analysis of a Canadian multicentre birth cohort derived from provincial data collected in 2008/2009. Maternal and perinatal characteristics and outcomes were compared between vaginal and cesarean birth and between the following MOD subgroups: spontaneous vaginal delivery (VD), assisted VD, planned cesarean delivery (CD), and intrapartum CD. Multivariate regression identified determinants of CD and the effects of MOD and previous CD on maternal and perinatal outcomes. Results: The cohort included 264 755 births (72.1% VD and 27.9% CD) from 91 participating institutions. Determinants of CD included maternal age, parity, previous CD, chronic hypertension, diabetes, urinary tract infection or pyelonephritis, gestational hypertension, vaginal bleeding, labour induction, pre-term gestational age, low birth weight, large for gestational age, malpresentation, and male sex. CD was associated with greater risk of maternal and perinatal morbidity and mortality. Subgroup analysis demonstrated higher risk of adverse pregnancy outcomes with assisted VD and intrapartum CD than spontaneous VD. Planned CD reduced the risk of obstetric wound hematoma and perinatal mortality but increased maternal and neonatal morbidity. Previous CD increased the risk of maternal and neonatal morbidity among multiparous women. Conclusions: The CD rate in Canada is consistent with global trends reflecting demographic and obstetric intervention factors. The risk of adverse pregnancy outcomes with CD warrants evaluation of interventions to safely prevent nonessential cesarean birth.

KW - cesarean section

KW - delivery, obstetric

KW - maternal outcomes

KW - obstetrical forceps

KW - pregnancy outcome

KW - vacuum extraction, obstetrical

UR - http://www.scopus.com/inward/record.url?scp=85133789142&partnerID=8YFLogxK

U2 - 10.1016/j.jogc.2022.04.017

DO - 10.1016/j.jogc.2022.04.017

M3 - Article

C2 - 35595024

AN - SCOPUS:85133789142

SN - 1701-2163

VL - 44

SP - 960

EP - 971

JO - Journal of Obstetrics and Gynaecology Canada

JF - Journal of Obstetrics and Gynaecology Canada

IS - 9

ER -

Survey of Mode of Delivery and Maternal and Perinatal Outcomes in Canada

Abstract

Keywords

UN SDGs

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