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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Veröffentlicht in:	Acta obstetricia et gynecologica Scandinavica Jg. 96; H. 5; S. 607 - 616
Hauptverfasser:	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
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States John Wiley & Sons, Inc 01.05.2017
Schlagworte:	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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Abstract	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.
AbstractList	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. 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. INTRODUCTIONThe 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 METHODSRetrospective 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.RESULTSBetween 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.CONCLUSIONSThe 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. 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. 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. 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. 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.
Author	Bjarnadóttir, Ragnheiður I. Bergholt, Thomas Rasmussen, Steen C. Albrechtsen, Susanne Skjeldestad, Finn E. Klungsoyr, Kari Smárason, Alexander Tapper, Anna‐Maija Pyykönen, Aura Källén, Karin Gissler, Mika Másdóttir, Birna B. Løkkegaard, Ellen
Author_xml	– sequence: 1 givenname: Aura orcidid: 0000-0001-9968-6660 surname: Pyykönen fullname: Pyykönen, Aura email: aura.pyykonen@helsinki.fi organization: Helsinki University Hospital – sequence: 2 givenname: Mika orcidid: 0000-0001-8254-7525 surname: Gissler fullname: Gissler, Mika organization: Karolinska Institute – sequence: 3 givenname: Ellen surname: Løkkegaard fullname: Løkkegaard, Ellen organization: Nordsjælland Hospital – sequence: 4 givenname: Thomas surname: Bergholt fullname: Bergholt, Thomas organization: Rigshospitalet – sequence: 5 givenname: Steen C. surname: Rasmussen fullname: Rasmussen, Steen C. organization: Rigshospitalet – sequence: 6 givenname: Alexander surname: Smárason fullname: Smárason, Alexander organization: University of Akureyri – sequence: 7 givenname: Ragnheiður I. orcidid: 0000-0003-0503-1319 surname: Bjarnadóttir fullname: Bjarnadóttir, Ragnheiður I. organization: Landspitali University Hospital – sequence: 8 givenname: Birna B. surname: Másdóttir fullname: Másdóttir, Birna B. organization: Landspitali University Hospital – sequence: 9 givenname: Karin orcidid: 0000-0001-5765-2630 surname: Källén fullname: Källén, Karin organization: University of Lund – sequence: 10 givenname: Kari surname: Klungsoyr fullname: Klungsoyr, Kari organization: University of Bergen – sequence: 11 givenname: Susanne surname: Albrechtsen fullname: Albrechtsen, Susanne organization: Haukeland University Hospital – sequence: 12 givenname: Finn E. surname: Skjeldestad fullname: Skjeldestad, Finn E. organization: UiT the Arctic University of Norway – sequence: 13 givenname: Anna‐Maija orcidid: 0000-0001-9352-0125 surname: Tapper fullname: Tapper, Anna‐Maija organization: Hyvinkää Hospital
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Copyright	2017 Nordic Federation of Societies of Obstetrics and Gynecology 2017 Nordic Federation of Societies of Obstetrics and Gynecology. Copyright © 2017 Acta Obstetricia et Gynecologica Scandinavica
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CorporateAuthor	Miljöepidemiologi Section V Institutionen för kliniska vetenskaper, Lund Lunds universitet Profile areas and other strong research environments Department of Laboratory Medicine Lund University Avdelningen för arbets- och miljömedicin Sektion V Obstetrics and Gynaecology (Lund) Institutionen för laboratoriemedicin Department of Clinical Sciences, Lund Division of Occupational and Environmental Medicine, Lund University Strategiska forskningsområden (SFO) EpiHealth: Epidemiology for Health Obstetrik och gynekologi, Lund Faculty of Medicine Strategic research areas (SRA) Medicinska fakulteten Environmental Epidemiology Tornblad Institute Profilområden och andra starka forskningsmiljöer Tornbladinstitutet
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Snippet	Introduction The cesarean rates are low but increasing in most Nordic countries. Using the Robson classification, we analyzed which obstetric groups have... The cesarean rates are low but increasing in most Nordic countries. Using the Robson classification, we analyzed which obstetric groups have contributed to the... Introduction The cesarean rates are low but increasing in most Nordic countries. Using the Robson classification, we analyzed which obstetric groups have... INTRODUCTIONThe cesarean rates are low but increasing in most Nordic countries. Using the Robson classification, we analyzed which obstetric groups have... Introduction: The cesarean rates are low but increasing in most Nordic countries. Using the Robson classification, we analyzed which obstetric groups have...
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SubjectTerms	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
Title	Cesarean section trends in the Nordic Countries – a comparative analysis with the Robson classification
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