Cesarean section trends in the Nordic Countries – a comparative analysis with the Robson classification
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Cesarean section trends in the Nordic Countries – a comparative analysis with the Robson classification. / 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.
I: Acta Obstetricia et Gynecologica Scandinavica, Bind 96, Nr. 5, 01.05.2017, s. 607-616.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Cesarean section trends in the Nordic Countries – a comparative analysis with the Robson classification
AU - Pyykönen, Aura
AU - Gissler, Mika
AU - Løkkegaard, Ellen
AU - Bergholt, Thomas
AU - Rasmussen, Steen C.
AU - Smárason, Alexander
AU - Bjarnadóttir, Ragnheiður I.
AU - Másdóttir, Birna B.
AU - Källén, Karin
AU - Klungsoyr, Kari
AU - Albrechtsen, Susanne
AU - Skjeldestad, Finn E.
AU - Tapper, Anna Maija
PY - 2017/5/1
Y1 - 2017/5/1
N2 - 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.
AB - 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.
KW - Cesarean section
KW - delivery
KW - induction of labor
KW - Robson classification
KW - uterine scar
UR - http://www.scopus.com/inward/record.url?scp=85016403859&partnerID=8YFLogxK
U2 - 10.1111/aogs.13108
DO - 10.1111/aogs.13108
M3 - Journal article
C2 - 28176334
AN - SCOPUS:85016403859
VL - 96
SP - 607
EP - 616
JO - Acta Obstetricia et Gynecologica Scandinavica
JF - Acta Obstetricia et Gynecologica Scandinavica
SN - 0001-6349
IS - 5
ER -
ID: 193317141