Tapia Vilma, Betran Ana Pilar, Gonzales Gustavo F
Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru.
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
PLoS One. 2016 Feb 3;11(2):e0148138. doi: 10.1371/journal.pone.0148138. eCollection 2016.
Cesarean section rates continue to increase worldwide while the reasons appear to be multiple, complex and, in many cases, country specific. Over the last decades, several classification systems for caesarean section have been created and proposed to monitor and compare caesarean section rates in a standardized, reliable, consistent and action-oriented manner with the aim to understand the drivers and contributors of this trend. The aims of the present study were to conduct an analysis in the three Peruvian geographical regions to assess levels and trends of delivery by caesarean section using the Robson classification for caesarean section, identify the groups of women with highest caesarean section rates and assess variation of maternal and perinatal outcomes according to caesarean section levels in each group over time.
Data from 549,681 pregnant women included in the Peruvian Perinatal Information System database from 43 maternal facilities in three Peruvian geographical regions from 2000 and 2010 were studied. The data were analyzed using the Robson classification and women were studied in the ten groups in the classification. Cochran-Armitage test was used to evaluate time trends in the rates of caesarean section rates and; logistic regression was used to evaluate risk for each classification.
The caesarean section rate was 27% and a yearly increase in the overall caesarean section rates from 2000 to 2010 from 23.5% to 30% (time trend p<0.001) was observed. Robson groups 1, 3 (nulliparous and multiparas, respectively, with a single cephalic term pregnancy in spontaneous labour), 5 (multiparas with a previous uterine scar with a single, cephalic, term pregnancy) and 7 (multiparas with a single breech pregnancy with or without previous scars) showed an increase in the caesarean section rates over time. Robson groups 1 and 3 were significantly associated with stillbirths (OR 1.43, CI95% 1.17-1.72; OR 3.53, CI95% 2.95-4.2) and maternal mortality (OR 3.39, CI95% 1.59-7.22; OR 8.05, CI95% 3.34-19.41).
The caesarean section rates increased in the last years as result of increased CS in groups with spontaneous labor and in-group of multiparas with a scarred uterus. Women included in groups 1 y 3 were associated to maternal perinatal complications. Women with previous cesarean section constitute the most important determinant of overall cesarean section rates. The use of Robson classification becomes an useful tool for monitoring cesarean section in low human development index countries.
剖宫产率在全球范围内持续上升，其原因似乎多种多样、错综复杂，且在许多情况下因国家而异。在过去几十年中，已创建并提出了几种剖宫产分类系统，旨在以标准化、可靠、一致且注重行动的方式监测和比较剖宫产率，以了解这一趋势的驱动因素和促成因素。本研究的目的是在秘鲁的三个地理区域进行分析，使用剖宫产罗布森分类法评估剖宫产分娩的水平和趋势，确定剖宫产率最高的女性群体，并评估每组剖宫产水平随时间变化的孕产妇和围产期结局差异。
研究了2000年至2010年期间秘鲁三个地理区域43个孕产妇机构纳入秘鲁围产期信息系统数据库的549,681名孕妇的数据。使用罗布森分类法对数据进行分析，将女性分为该分类法中的十个组进行研究。采用 Cochr an - Armitage检验评估剖宫产率的时间趋势；使用逻辑回归评估每个分类的风险。
剖宫产率为27%，观察到2000年至2010年期间总体剖宫产率从23.5%逐年上升至30%（时间趋势p<0.001）。罗布森组1、3（分别为初产妇和经产妇，单头位足月妊娠且自然分娩）、5（有子宫瘢痕史的经产妇，单头位足月妊娠）和7（单臀位妊娠的经产妇，有或无既往瘢痕）的剖宫产率随时间增加。罗布森组1和3与死产（OR 1.43，CI95% 1.17 - 1.72；OR 3.53，CI95% 2.95 - 4.2）和孕产妇死亡率（OR 3.39，CI95% 1.59 - 7.22；OR 8.05，CI95% 3.34 - 19.41）显著相关。
近年来剖宫产率上升是由于自然分娩组和有子宫瘢痕的经产妇组剖宫产增加所致。纳入组1和3的女性与孕产妇围产期并发症相关。既往有剖宫产史的女性是总体剖宫产率的最重要决定因素。罗布森分类法成为监测人类发展指数较低国家剖宫产情况的有用工具。
