title: Determinants of cesarean delivery: a classification tree analysis.
abstract: BACKGROUND
  Cesarean delivery (CD) rates are rising in many parts of the world. To define strategies to reduce them, it is important to identify their clinical and organizational determinants. The objective of this cross-sectional study is to identify sub-types of women at higher risk of CD using demographic, clinical and organizational variables.
  
  
  METHODS
  All hospital discharge records of women who delivered between 2005 and mid-2010 in the Emilia-Romagna Region of Italy were retrieved and linked with birth certificates. Sociodemographic and clinical information was retrieved from the two data sources. Organizational variables included activity volume (number of births per year), hospital type, and hour and day of delivery. A classification tree analysis was used to identify the variables and the combinations of variables that best discriminated cesarean from vaginal delivery.
  
  
  RESULTS
  The classification tree analysis indicated that the most important variables discriminating the sub-groups of women at different risk of cesarean section were: previous cesarean, mal-position/mal-presentation, fetal distress, and abruptio placentae or placenta previa or ante-partum hemorrhage. These variables account for more than 60% of all cesarean deliveries. A sensitivity analysis identified multiparity and fetal weight as additional discriminatory variables.
  
  
  CONCLUSIONS
  Clinical variables are important predictors of CD. To reduce the CD rate, audit activities should examine in more detail the clinical conditions for which the need of CD is questionable or inappropriate.
authors: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy. elisa.stivanello2@unibo.it.
authors: Elisa
authors: E
authors: Stivanello
authors: Paola
authors: P
authors: Rucci
authors: Jacopo
authors: J
authors: Lenzi
authors: Maria Pia
authors: MP
authors: Fantini
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000145:classification / Q000706:statistics & numerical data*; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D005316:Fetal Distress / Q000453:epidemiology*; D020567:Fetal Weight; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007746:Labor Presentation; D010298:Parity; D010923:Placenta Previa / Q000453:epidemiology*; D011247:Pregnancy; D012307:Risk Factors; D014592:Uterine Hemorrhage / Q000453:epidemiology*; D055815:Young Adult