Evidence map›Paper›PMID 36746486›Full record

ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2023

Hospital factors associated with maternal and neonatal outcomes of deliveries to patients with a previous cesarean delivery: an ecological study.

K S Joseph, Carmen B Young, Giulia M Muraca, Amélie Boutin, Neda Razaz, Sid John, Sarka Lisonkova, R Douglas Wilson

Abstract readEvaluation Study
PubMed Full text at PMC Publisher
In one paragraph

Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Hospital obstetric volume and maternal outcomes: Does hospital size matter?Acta obstetricia et gynecologica Scandinavica · 2025
    Article
  3. Fostering Excellence in Obstetrical Surgery.Journal of healthcare leadership · 2023
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

K S JosephDepartment of Obstetrics and Gynaecology (Joseph, John, Lisonkova), University of British Columbia; Children's and Women's Hospital (Joseph, John, Lisonkova), Health Centre of British Columbia; School of Population and Public Health (Joseph, Lisonkova), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Obstetrics and Gynecology, and Health Research Methods, Evidence, and Impact (Muraca), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Boutin), Faculty of Medicine, Université Laval and CHU de Québec-Université Laval Research Center, Québec, Que.; Division of Clinical Epidemiology (Razaz), Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Wilson), Cumming School of Medicine, University of Calgary, Calgary, Alta. ksjoseph@bcchr.ca.
Carmen B YoungDepartment of Obstetrics and Gynaecology (Joseph, John, Lisonkova), University of British Columbia; Children's and Women's Hospital (Joseph, John, Lisonkova), Health Centre of British Columbia; School of Population and Public Health (Joseph, Lisonkova), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Obstetrics and Gynecology, and Health Research Methods, Evidence, and Impact (Muraca), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Boutin), Faculty of Medicine, Université Laval and CHU de Québec-Université Laval Research Center, Québec, Que.; Division of Clinical Epidemiology (Razaz), Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Wilson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
Giulia M MuracaDepartment of Obstetrics and Gynaecology (Joseph, John, Lisonkova), University of British Columbia; Children's and Women's Hospital (Joseph, John, Lisonkova), Health Centre of British Columbia; School of Population and Public Health (Joseph, Lisonkova), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Obstetrics and Gynecology, and Health Research Methods, Evidence, and Impact (Muraca), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Boutin), Faculty of Medicine, Université Laval and CHU de Québec-Université Laval Research Center, Québec, Que.; Division of Clinical Epidemiology (Razaz), Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Wilson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
Amélie BoutinDepartment of Obstetrics and Gynaecology (Joseph, John, Lisonkova), University of British Columbia; Children's and Women's Hospital (Joseph, John, Lisonkova), Health Centre of British Columbia; School of Population and Public Health (Joseph, Lisonkova), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Obstetrics and Gynecology, and Health Research Methods, Evidence, and Impact (Muraca), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Boutin), Faculty of Medicine, Université Laval and CHU de Québec-Université Laval Research Center, Québec, Que.; Division of Clinical Epidemiology (Razaz), Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Wilson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
Neda RazazDepartment of Obstetrics and Gynaecology (Joseph, John, Lisonkova), University of British Columbia; Children's and Women's Hospital (Joseph, John, Lisonkova), Health Centre of British Columbia; School of Population and Public Health (Joseph, Lisonkova), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Obstetrics and Gynecology, and Health Research Methods, Evidence, and Impact (Muraca), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Boutin), Faculty of Medicine, Université Laval and CHU de Québec-Université Laval Research Center, Québec, Que.; Division of Clinical Epidemiology (Razaz), Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Wilson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
Sid JohnDepartment of Obstetrics and Gynaecology (Joseph, John, Lisonkova), University of British Columbia; Children's and Women's Hospital (Joseph, John, Lisonkova), Health Centre of British Columbia; School of Population and Public Health (Joseph, Lisonkova), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Obstetrics and Gynecology, and Health Research Methods, Evidence, and Impact (Muraca), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Boutin), Faculty of Medicine, Université Laval and CHU de Québec-Université Laval Research Center, Québec, Que.; Division of Clinical Epidemiology (Razaz), Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Wilson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
Sarka LisonkovaDepartment of Obstetrics and Gynaecology (Joseph, John, Lisonkova), University of British Columbia; Children's and Women's Hospital (Joseph, John, Lisonkova), Health Centre of British Columbia; School of Population and Public Health (Joseph, Lisonkova), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Obstetrics and Gynecology, and Health Research Methods, Evidence, and Impact (Muraca), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Boutin), Faculty of Medicine, Université Laval and CHU de Québec-Université Laval Research Center, Québec, Que.; Division of Clinical Epidemiology (Razaz), Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Wilson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
R Douglas WilsonDepartment of Obstetrics and Gynaecology (Joseph, John, Lisonkova), University of British Columbia; Children's and Women's Hospital (Joseph, John, Lisonkova), Health Centre of British Columbia; School of Population and Public Health (Joseph, Lisonkova), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology (Young), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Departments of Obstetrics and Gynecology, and Health Research Methods, Evidence, and Impact (Muraca), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Boutin), Faculty of Medicine, Université Laval and CHU de Québec-Université Laval Research Center, Québec, Que.; Division of Clinical Epidemiology (Razaz), Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynecology (Wilson), Cumming School of Medicine, University of Calgary, Calgary, Alta.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRecommendations for deliveries of pregnant patients with a previous cesarean delivery and the type of hospitals deemed safe for these deliveries have evolved in recent years, although no studies have examined hospital factors and associated safety. We sought to evaluate maternal and neonatal outcomes among patients with a previous cesarean delivery by hospital tier and volume.

methodsWe carried out an ecological study of singleton live births delivered at term gestation to patients with a previous cesarean delivery in all Canadian hospitals (excluding Quebec), 2013-2019. We obtained data from the Discharge Abstract Database of the Canadian Institute for Health Information. The primary outcomes were severe maternal morbidity or mortality (SMMM), and serious neonatal morbidity or mortality (SNMM). We used regression modelling to examine hospital tier (tier 4 hospitals being those that provide the highest level of care) and volume; we also identified hospitals with high rates of SMMM and SNMM using within-tier comparisons and comparisons with the overall rate.

resultsWe included 235 442 deliveries to patients with a previous cesarean delivery; SMMM and SNMM rates were 14.6 per 1000 deliveries and 4.6 per 1000 live births, respectively. Among patients with a parity of 1, SMMM rates were lower in tier 1 hospitals (adjusted incidence rate ratio [IRR] 0.68, 95% confidence interval [CI] 0.52-0.89) and higher in tier 4 hospitals (adjusted IRR 1.41, 95% CI 1.05-1.91) than in tier 2 hospitals; SNMM rates did not differ by hospital tier. Rates of SNMM increased with increasing hospital volume (adjusted IRR 1.02, 95% CI 1.00-1.04) and increasing rates of vaginal birth after cesarean delivery (adjusted IRR 1.02, 95% CI 1.01-1.04). Most hospitals had relatively low SMMM and SNMM rates, although a few hospitals in each tier and volume category had significantly higher rates than others.

interpretationAdverse maternal and neonatal outcomes among patients with a previous cesarean delivery showed no clear pattern of decreasing SMMM and SNMM with increasing tiers of service and hospital volume. All hospitals, irrespective of tier or size, should continually review their rates of adverse maternal and neonatal outcomes.

Indexed as

Cesarean SectionHospitalsCanadaFemaleHumansInfant MortalityInfant, NewbornParityPregnancyRetrospective Studies

Identifiers

PMID36746486
PMCPMC9904811

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.