Chung W H, Kong C W, To W Wk
Department of Obstetrics and Gynaecology, United Christian Hospital, Kwun Tong, Hong Kong.
Hong Kong Med J. 2017 Aug;23(4):340-8. doi: 10.12809/hkmj176217. Epub 2017 Jul 7.
Although caesarean section rates have been increasing over the years in both public and private sectors in Hong Kong, there has been a paucity of formal surveys on local trends in such rates. This study aimed to examine the trends in caesarean section rates over a 20-year period at a public regional obstetric unit in Hong Kong using the Robson's Ten-group Classification System.
All deliveries in a single obstetric unit during a 20-year period (1995-2014) were classified into 10 subgroups according to the Robson's classification. The annual caesarean section rate for each subgroup was calculated and then stratified into 5-year intervals to analyse any significant trends.
The caesarean section rates in a total of 86 262 births with complete data were analysed. The overall caesarean section rate increased modestly from 15.4% to 24.6% during the study period. There was an obvious increasing trend for caesarean section in those with previous caesarean section (Robson's category 5), breech presentation at delivery (category 6 and 7), multiple pregnancy (category 8), and preterm labour (category 10). A gradual fall in caesarean section rate from 14.4% to 10.8% was seen in primiparous women with term spontaneous labour (category 1). Statistically significant differences (P<0.001) in these trends were confirmed when the data were stratified into 5-year intervals for comparison.
The rising caesarean section rate may be associated with clinical management policies that allow women with relative risk factors (such as breech, previous caesarean section, or multiple pregnancy) to opt for caesarean section. This rise was counterbalanced by a decrease in primary caesarean section rate in primiparous women with spontaneous labour. The trend for caesarean section was more in line with patient expectations rather than evidence-based practice.
尽管香港公私营部门的剖宫产率多年来一直在上升，但对于当地此类比率的趋势，正规调查却很匮乏。本研究旨在使用罗布森十组分类系统，调查香港某公共区域产科单位20年间的剖宫产率趋势。
在20年期间（1995 - 2014年），某单一产科单位的所有分娩根据罗布森分类法被分为10个亚组。计算每个亚组的年度剖宫产率，然后按5年间隔分层，以分析任何显著趋势。
对总共86262例有完整数据的分娩的剖宫产率进行了分析。在研究期间，总体剖宫产率从15.4%适度上升至24.6%。既往有剖宫产史者（罗布森分类第5类）、分娩时臀位者（第6和7类）、多胎妊娠者（第8类）以及早产者（第10类）的剖宫产率有明显上升趋势。足月自然分娩的初产妇（第1类）的剖宫产率从14.4%逐渐降至10.8%。当数据按5年间隔分层进行比较时，这些趋势的统计学显著差异（P<0.001）得到证实。
剖宫产率上升可能与临床管理政策有关，这些政策允许有相对危险因素（如臀位、既往剖宫产史或多胎妊娠）的女性选择剖宫产。这种上升被自然分娩初产妇的首次剖宫产率下降所抵消。剖宫产趋势更符合患者期望而非循证实践。
