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
University of Helsinki, Helsinki, Finland.
Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland.
Acta Obstet Gynecol Scand. 2017 May;96(5):607-616. doi: 10.1111/aogs.13108. Epub 2017 Mar 24.
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.
在大多数北欧国家，剖宫产率较低但呈上升趋势。我们使用罗布森分类法分析了哪些产科群体导致了剖宫产率的变化。
基于人群的回顾性登记研究，纳入了2000年至2011年丹麦、芬兰、冰岛、挪威和瑞典的所有分娩（3398586例）。对四个3年时间段进行全国范围内的罗布森组分布、剖宫产率及每组的贡献率分析。针对每个国家，我们分析了哪些群体导致了总剖宫产率的变化。
在研究的第一个时间段和最后一个时间段之间，丹麦（从16.4%增至20.7%）、挪威（从14.4%增至16.5%）和瑞典（从15.5%增至17.1%）的总剖宫产率有所上升，但在研究接近尾声时，剖宫产率趋于稳定甚至下降。上升主要是由于R5组（有剖宫产史的女性）和R2a组（初产妇引产）的绝对贡献率增加。在芬兰，剖宫产率略有下降（从16.5%降至16.2%），主要是由于R5组以及R6 - R7组（臀位分娩，初产妇/经产妇）的下降。在冰岛，所有产妇群体的剖宫产率均下降（从17.6%降至15.3%），尽管引产率有所上升，但主要是在初产妇中下降最为明显。
北欧国家总剖宫产率上升的原因是初产妇剖宫产率增加以及有剖宫产史女性的比例增加。同时，初产妇引产率显著上升，但对总剖宫产率的影响尚不清楚。罗布森分类法有助于为降低剖宫产率制定基准和确定目标。
