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Indicator Metadata

NameLow-Risk Caesarean Sections
Short/Other Names

Low-Risk Caesarean Section Rate

Description

This indicator measures the rate of deliveries via Caesarean section (C-section) among singleton term cephalic pregnancies for women without placenta previa or previous C-section.

For further details, please see the General Methodology Notes.

InterpretationSince unnecessary C-section delivery increases maternal morbidity and mortality and is associated with higher costs, C-section rates are often used to monitor clinical practices. The implicit assumption is that lower rates indicate more appropriate as well as more efficient care; therefore, variations in rates can serve as a flag to examine appropriateness of care, as well as maternal and neonatal outcomes.
HSP Framework Dimension

Health System Outputs: Appropriate and effective

Areas of Need

Getting Better

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region, Facility

Indicator Results

Accessing Indicator Results on Your Health System: In Depth

Identifying Information
NameLow-Risk Caesarean Sections
Short/Other Names

Low-Risk Caesarean Section Rate

Indicator Description and Calculation
Description

This indicator measures the rate of deliveries via Caesarean section (C-section) among singleton term cephalic pregnancies for women without placenta previa or previous C-section.

For further details, please see the General Methodology Notes.

Calculation: Description

The indicator is expressed as the rate of C-sections per 100 deliveries.

Risk-adjusted rate = Observed cases ÷ Expected cases × Canadian average

Unit of Analysis: Single admission

Calculation: Geographic Assignment

Place of service

Calculation: Type of Measurement

Rate - per 100

Calculation: Adjustment Applied

The following covariates are used in risk adjustment:
For a detailed list of covariates used in the model, please refer to the Model Specification document.

Calculation: Method of Adjustment

Logistic regression

Denominator

Description:
Hospitalizations where a singleton term cephalic delivery was recorded, excluding women with placenta previa or previous C-section
Inclusions:
1. Admission to an acute care institution (Facility Type Code = 1)

2. Sex recorded as female

3. Delivery code (ICD-10-CA: O10–O16, O21–O26, O28–O37, O40–O46, O48, O60–O75, O85–O92, O95 or O98–O99 with a sixth digit of 1 or 2 OR Z37 coded in any position)
Exclusions:
1. Newborn, stillbirth or cadaveric donor records (Admission Category Code = N, R or S)

2. Multiple gestations (ICD-10-CA: O30)

3. Pre-term delivery (gestational age at delivery <37 completed weeks)

4. Post-term delivery (gestational age at delivery >41 completed weeks)

5. Women with placenta previa (ICD-10-CA: O44.001, O44.101 — any diagnosis type)

6. Breech presentation (ICD-10-CA: O32.101, O64.101 — any diagnosis type)

7. Transverse/oblique lie (ICD-10-CA: O32.201 — any diagnosis type)

8. Women with previous C-section (ICD-10-CA: O75.701, O34.201, O66.401 — any diagnosis type)

9. Women with unknown age

10. 2013–2014 and onward:

Delivery in which an abortive procedure was recorded (code may be recorded in any position; procedures not coded as "out of hospital" or "abandoned after onset" (Intervention Status Attribute = A or OOH Indicator Flag = Y):

CCI: 5.CA.20.^^, 5.CA.24.^^, 5.CA.88.^^, 5.CA.89.^^ or 5.CA.93.^^

OR

ICD-10-CA: O04

Numerator

Description:
Cases within the denominator where a C-section delivery was recorded
Inclusions:
1. Cases within the denominator with a C-section delivery that was not performed out of hospital (CCI: 5.MD.60.^^ and OOH Indicator Flag does not equal Y)

Background, Interpretation and Benchmarks
Rationale

Across many Organisation for Economic Co-operation and Development countries, C-section delivery rates have been rising. The Society of Obstetricians and Gynaecologists of Canada promotes normal childbirth, without technological interventions, when possible.

Multiple, pre-term and post-term deliveries are among the main indications for a C-section delivery. In addition to these factors, women who experience conditions such as placenta previa and malpresentations (breech or transverse positions) or who have had a previous C-section may also require a C-section. By excluding these complex cases, the measure seeks to focus on a population with a lower risk of C-section. The measure is intended to be used as a flag to identify areas for improvement and to help reduce C-section rates. Similar measures have been used in the United States to investigate the rates of C-sections for low-risk pregnancies.

Interpretation

Since unnecessary C-section delivery increases maternal morbidity and mortality and is associated with higher costs, C-section rates are often used to monitor clinical practices. The implicit assumption is that lower rates indicate more appropriate as well as more efficient care; therefore, variations in rates can serve as a flag to examine appropriateness of care, as well as maternal and neonatal outcomes.

HSP Framework Dimension

Health System Outputs: Appropriate and effective

Areas of Need

Getting Better

Targets/Benchmarks

Not applicable

References

OECD. Health at a Glance 2013: OECD Indicators. Available at http://dx.doi.org/10.1787/health_glance-2013-en. Published November, 2013. Accessed February 12, 2014.

Society of Obstetricians and Gynaecologists of Canada et al. Joint Policy Statement on Normal Childbirth. J Obstet Gynaecol Can. 2008;30(12):1163-1165.

Public Health Agency of Canada. Canadian Perinatal Health Report, 2008 Edition. Available at http://www.phac-aspc.gc.ca/publicat/2008/cphr-rspc/pdf/cphr-rspc08-eng.pdf. Updated 2008. Accessed February 12, 2014.

Canadian Institute for Health Information. Health Indicators 2009. Ottawa, ON: CIHI; 2009.

Millar WJ, Nair C, Wadhera S. Declining cesarean section rates: a continuing trend? Health Rep. 1996;8(1):17-24.

Moradan S, Nejad SP. The Prevalence and Route of Delivery of Prolonged Pregnancies. Kuwait Med J. 2012; 44(2) :118

Oppenheimer L. Diagnosis and management of placenta previa. J Obstet Gynaecol Can. 2007;29(3): 261.

Herstad L, KLUNGSØYR K, Skjaerven R, et al. Maternal age and elective cesarean section in a low-risk population. Acta Obstet Gynecol Scand. 2012;91(7):816-823.

Martel MJ & MacKinnon CJ. Guidelines for vaginal birth after previous Caesarean birth. J Obstet Gynaecol Can. 2005;27(2):164.

Yeh J, Wactawski-Wende J, Shelton JA, et al. Temporal trends in the rates of trial of labor in low-risk pregnancies and their impact on the rates and success of vaginal birth after cesarean delivery. Am J Obstet Gynecol. 2006;194(1):144-e1.

The Joint Commission. Perinatal Care. Specifications Manual for Joint Commission National Quality Measures. 2014A. PC-02.

Availability of Data Sources and Results
Data Sources

DAD, HMDB

Available Data Years

Type of Year:
Fiscal
First Available Year:
2011
Last Available Year:
2015

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region, Facility

Result Updates
Update Frequency

Every year

Indicator Results

Web Tool:
Your Health System: In Depth
URL:
Accessing Indicator Results on Your Health System: In Depth

Updates

Not applicable

Quality Statement
Caveats and Limitations

Not applicable

Trending Issues

Not applicable

Comments

Not applicable