Cesarean delivery in the United Kingdom: time trends in the general practice research database.
OBJECTIVE
To estimate recent temporal trends in delivery by cesarean during the past decade and the proportion of vaginal deliveries after prior caesarean in the United Kingdom.


METHODS
We conducted a cohort study using information from the General Practice Research Database. We identified all women with 1 or more deliveries between January 1990 and December 1999 and determined the method(s) of delivery. We estimated the proportion of women with vaginal delivery after cesarean in a subcohort who had at least 3 years of follow-up.


RESULTS
We identified 39,938 cesareans among 271,663 deliveries (14.7%), with an increase from 12.5% in 1990 to 18.3% in 1999. The proportion of cesarean deliveries increased with age and increased over time in all age groups except women aged younger than 20 years. Among 26,480 women with a caesarean delivery between 1990 and 1996, 7,649 (28.9%) had a subsequent delivery. The proportion of vaginal delivery after prior cesarean decreased from 45% in 1991 to 37% in 1999.


CONCLUSIONS
Cesarean deliveries increased as a proportion of all deliveries in the United Kingdom during the past decade, and the proportion of vaginal delivery after prior cesarean decreased. Still, the proportion of cesarean deliveries is lower and the proportion of vaginal deliveries after prior cesarean is higher in the United Kingdom than in the United States.


METHODS
II-2.
Black
Corri
C
Department of Public Health, University of Aberdeen, Scotland. corri.black@abdn.ac.uk
Kaye
James A
JA
Jick
Hershel
H
D000328:Adult; D000367:Age Factors; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D016001:Confidence Intervals; D036861:Delivery, Obstetric / Q000592:standards / Q000639:trends; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008423:Maternal Age; D015999:Multivariate Analysis; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D011336:Probability; D012042:Registries; D018570:Risk Assessment; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology