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  • Postoperative Antimicrobial Prophylaxis Following Cesarean Delivery in Obese Women: An Exception to the Rule?

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    JAMA. 2017; 318(11):1012-1013. doi: 10.1001/jama.2017.10535
  • Effect of Post–Cesarean Delivery Oral Cephalexin and Metronidazole on Surgical Site Infection Among Obese Women: A Randomized Clinical Trial

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    JAMA. 2017; 318(11):1026-1034. doi: 10.1001/jama.2017.10567

    This randomized trial compares the effects of postoperative oral cephalexin-metronidazole vs placebo on frequency of surgical site infection (SSI) in obese women undergoing cesarean delivery.

  • Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis

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    JAMA. 2017; 317(21):2207-2225. doi: 10.1001/jama.2017.3635

    This meta-analysis evaluates associations between gestational weight gain above or below the Institute of Medicine guidelines and maternal and infant outcomes including size for gestational age, preterm birth, cesarean delivery, and gestational diabetes mellitus.

  • JAMA January 3, 2017

    Figure 2: Trends in Cesarean Rates, 2008-2014, by Degree of Urbanization in 2014, County Cesarean Rate in 2008, and County Gross Domestic Product per Capita in 2008

    Rural refers to rural areas of a city, general city refers to urban areas of a city with a population of less than 5 million, and super city refers to urban areas of a city with a population of ≥5 million. A, As estimated by Poisson regression analyses with generalized estimating equations, the annual percent changes in cesarean delivery rate were −1.6 (95% CI, −2.1 to −1.0; P < .001) for super cities, 1.3 (95% CI, 0.9 to 1.7; P < .001) for general cities, and 4.9 (95% CI, 4.5 to 5.2; P < .001) for rural areas. B, −1.1 (95% CI, −1.4 to −0.8; P < .001) for counties with cesarean rate of 45% or higher, 3.1 (95% CI, 2.7 to 3.4; P < .001) for counties with cesarean rates ranging from 30% to 45%, and 8.8 (95% CI, 8.5 to 9.2; P < .001) for counties with cesarean rates that are less than 30%. C, 2.4 (95% CI, 2.0 to 2.8; P < .001) for counties with the highest gross domestic product (GDP) per capita, 5.0 (95% CI, 4.5 to 5.5; P < .001) for counties with the midrange GDP, and 7.1 (95% CI, 6.4 to 7.7; P < .001) for counties in the lowest GDP per capita group.
  • Geographic Variations and Temporal Trends in Cesarean Delivery Rates in China, 2008-2014

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    JAMA. 2017; 317(1):69-76. doi: 10.1001/jama.2016.18663

    This population epidemiology study describes the trends in the rate of cesarean deliveries and maternal and perinatal deaths in mainland China, 2008-2014.

  • Temporal Trends in Late Preterm and Early Term Birth Rates in 6 High-Income Countries in North America and Europe and Association With Clinician-Initiated Obstetric Interventions

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    JAMA. 2016; 316(4):410-419. doi: 10.1001/jama.2016.9635

    This study analyzed national and population-based birth registry data from Canada, Denmark, Finland, Norway, Sweden, and the United States to describe recent trends in late preterm and early term birth rates and assess association with use of clinician-initiated obstetric interventions.

  • Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality

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    JAMA. 2015; 314(21):2263-2270. doi: 10.1001/jama.2015.15553

    This ecological study uses World Bank World Development database data to investigate associations between national cesarean delivery rates and maternal and neonatal mortality rates in 194 World Health Organization member countries in 2012.

  • JAMA December 1, 2015

    Figure 1: Relation Between Maternal Mortality Ratio in 2013 and Cesarean Delivery Rate (per 100 Live Births) in 2012 for 181 Countries

    Thirteen countries did not have maternal mortality ratio data for 2013. The maternal mortality ratio was derived from death from pregnancy-related causes while pregnant or up to 42 days postpartum per 100 000 live births. Change points correspond with the following cesarean delivery rates: 7.2, 19.1, and 27.3. The blue shade indicates 95% CIs. The curve was fit to the data by spline regression models using the maximum cross-validation–adjusted R2 to choose the number of change points.
  • JAMA December 1, 2015

    Figure 2: Relation Between Neonatal Mortality Rate (per 100 Live Births in 2012) and Cesarean Delivery Rate (per 100 Live Births) in 2012 for 191 Countries

    Three countries did not have neonatal mortality rate data for 2012. The change point corresponds with a cesarean delivery rate of 19.4. The blue shade indicates 95% CIs. The curve was fit to the data by spline regression models using the maximum cross-validation–adjusted R2 to choose the number of change points.
  • Planned Cesarean Delivery at Term and Adverse Outcomes in Childhood Health

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    JAMA. 2015; 314(21):2271-2279. doi: 10.1001/jama.2015.16176

    This population epidemiology study uses national health databases in Scotland to investigate associations between planned cesarean delivery in a first pregnancy and childhood asthma requiring hospital admission between 1993 and 2015.

  • Cesarean Delivery Rates: Revisiting a 3-Decades-Old Dogma

    Abstract Full Text
    JAMA. 2015; 314(21):2238-2240. doi: 10.1001/jama.2015.15948
  • Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012

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    JAMA. 2015; 314(10):1039-1051. doi: 10.1001/jama.2015.10244

    This population epidemiology study used neonatal registry data to characterize trends in maternal and neonatal care, and morbidity and mortality of extremely preterm infants between 1993 and 2012.

  • JAMA September 8, 2015

    Figure 1: Care Practices for Infants Born at Gestational Ages 22 through 28 Weeks

    Circles indicate the percent of infants born each year who received the practice, the smoothed curve shows the trend, and shading indicates the 95% CI for the curve. Shading is not visible where CIs are close to values on the curve. Percentages are among all infants except those for postnatal steroids (which include only infants who survived >12 hours; this outcome was not collected for infants who died ≤12 hours of age). Adjusted relative risks (RRs) are based on infants of all gestational ages and are shown for outcomes for which the year-gestational age interaction was not significant. When the year-gestational age interaction was significant, graphs and RRs are shown for each gestational age in eFigures 1-4 in the Supplement. RRs for the change per year were adjusted for study center, maternal race/ethnicity, infant gestational age, small size for gestational age, and sex. Total number of infants (mean [range] per year): 34 576 (1728 [1214-2022]) for antenatal steroids; 34 531 (1726 [1210-2020]) for antenatal antibiotics; 34 611 (1730 [1213-2024]) for cesarean delivery; 34 611 (1730 [1214-2024]) for intubation; 34 599 (1729 [1214-2023]) for surfactant; and 30 645 (1532 [1036-1802]) for postnatal steroids.
  • Clinician Training Reduces Cesarean Rates in Low-Risk Pregnancies

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    JAMA. 2015; 313(24):2416-2416. doi: 10.1001/jama.2015.6590
  • Association Between Hospital-Level Obstetric Quality Indicators and Maternal and Neonatal Morbidity

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    JAMA. 2014; 312(15):1531-1541. doi: 10.1001/jama.2014.13381

    This population-based observational study reports that use of 2 Joint Commission obstetric quality indicators are not associated with maternal and neonatal morbidity.

  • JAMA October 15, 2014

    Figure: Risk-Standardized Severe Maternal and Neonatal Morbidity by Quality Indicators

    aN = 41 hospitals. Top 10 on the quality measures indicates lowest rate for elective and cesarean deliveries; bottom 10, highest rates.
  • No Increase in Cesarean Deliveries

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    JAMA. 2013; 310(6):574-574. doi: 10.1001/jama.2013.76465
  • Elective Cesarean Delivery on Maternal Request

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    JAMA. 2013; 309(18):1930-1936. doi: 10.1001/jama.2013.3982
    Ecker reviews evidence and discusses approaches for counseling pregnant women who ask for cesarean delivery without maternal or fetal indication.