Cesarean section trends in the Nordic Countries – a comparative analysis with the Robson classification

Introduction The cesarean rates are low but increasing in most Nordic countries. Using the Robson classification, we analyzed which obstetric groups have contributed to the changes in the cesarean rates. Material and methods Retrospective population‐based registry study including all deliveries (3 3...

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Vydáno v:Acta obstetricia et gynecologica Scandinavica Ročník 96; číslo 5; s. 607 - 616
Hlavní autoři: Pyykönen, Aura, Gissler, Mika, Løkkegaard, Ellen, Bergholt, Thomas, Rasmussen, Steen C., Smárason, Alexander, Bjarnadóttir, Ragnheiður I., Másdóttir, Birna B., Källén, Karin, Klungsoyr, Kari, Albrechtsen, Susanne, Skjeldestad, Finn E., Tapper, Anna‐Maija
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States John Wiley & Sons, Inc 01.05.2017
Témata:
Cesarean section
Cesarean Section - statistics & numerical data
Cesarean Section - trends
Classification
Clinical Medicine
Databases, Factual
delivery
Female
Gynaecology, Obstetrics and Reproductive Medicine
Gynekologi, obstetrik och reproduktionsmedicin
Health risk assessment
Humans
induction of labor
Infant, Newborn
Klinisk medicin
Maternal Health Services - statistics & numerical data
Maternal Health Services - trends
Medical and Health Sciences
Medicin och hälsovetenskap
Physicians
Pregnancy
Pregnancy Outcome
Retrospective Studies
Robson classification
Scandinavian and Nordic Countries - epidemiology
uterine scar
Robson classification
delivery
induction of labor
uterine scar
Cesarean section
ISSN:0001-6349, 1600-0412
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Shrnutí:Introduction The cesarean rates are low but increasing in most Nordic countries. Using the Robson classification, we analyzed which obstetric groups have contributed to the changes in the cesarean rates. Material and methods Retrospective population‐based registry study including all deliveries (3 398 586) between 2000 and 2011 in Denmark, Finland, Iceland, Norway and Sweden. The Robson group distribution, cesarean rate and contribution of each Robson group were analyzed nationally for four 3‐year time periods. For each country, we analyzed which groups contributed to the change in the total cesarean rate. Results Between the first and the last time period studied, the total cesarean rates increased in Denmark (16.4 to 20.7%), Norway (14.4 to 16.5%) and Sweden (15.5 to 17.1%), but towards the end of our study, the cesarean rates stabilized or even decreased. The increase was explained mainly by increases in the absolute contribution from R5 (women with previous cesarean) and R2a (induced labor on nulliparous). In Finland, the cesarean rate decreased slightly (16.5 to 16.2%) mainly due to decrease among R5 and R6–R7 (breech presentation, nulliparous/multiparous). In Iceland, the cesarean rate decreased in all parturient groups (17.6 to 15.3%), most essentially among nulliparous women despite the increased induction rates. Conclusions The increased total cesarean rates in the Nordic countries are explained by increased cesarean rates among nulliparous women, and by an increased percentage of women with previous cesarean. Meanwhile, induction rates on nulliparous increased significantly, but the impact on the total cesarean rate was unclear. The Robson classification facilitates benchmarking and targeting efforts for lowering the cesarean rates.
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ISSN:0001-6349
1600-0412
DOI:10.1111/aogs.13108