Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Obstetrics and Gynecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland.
Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY.
Am J Obstet Gynecol. 2018 Jul;219(1):105.e1-105.e11. doi: 10.1016/j.ajog.2018.04.012. Epub 2018 Apr 12.
Cesarean delivery has increased steadily in the United States over recent decades with significant downstream health consequences. The World Health Organization has endorsed the Robson 10-Group Classification System as a global standard to facilitate analysis and comparison of cesarean delivery rates.
Our objective was to apply the Robson 10-Group Classification System to a nationwide cohort in the United States over a 10-year period.
This population-based analysis applied the Robson 10-Group Classification System to all births in the United States from 2005 through 2014, recorded in the 2003 revised birth certificate format. Over the study 10-year period, 27,044,217 deliveries met inclusion criteria. Five parameters (parity including previous cesarean, gestational age, labor onset, fetal presentation, and plurality), identifiable on presentation for delivery, were used to classify all women included into 1 of 10 groups.
The overall cesarean rate was 31.6%. Group-3 births (singleton, term, cephalic multiparas in spontaneous labor) were most common, while group-5 births (those with a previous cesarean) accounted for the most cesarean deliveries increasing from 27% of all cesareans in 2005 through 2006 to >34% in 2013 through 2014. Breech pregnancies (groups 6 and 7) had cesarean rates >90%. Primiparous and multiparous women who had a prelabor cesarean (groups 2b and 4b) accounted for over one quarter of all cesarean deliveries.
Women with a previous cesarean delivery represent an increasing proportion of cesarean deliveries. Use of the Robson criteria allows standardized comparisons of data and identifies clinical scenarios driving changes in cesarean rates. Hospitals and health organizations can use the Robson 10-Group Classification System to evaluate quality and processes associated with cesarean delivery.
近几十年来，美国的剖宫产率稳步上升，随之带来了显著的下游健康后果。世界卫生组织已认可 Robson 10 组分类系统为全球标准，以促进剖宫产率的分析和比较。
我们的目的是在过去 10 年中，在美国全国范围内的队列中应用 Robson 10 组分类系统。
本基于人群的分析应用 Robson 10 组分类系统对美国 2005 年至 2014 年期间所有的出生记录进行分类，这些出生记录均采用 2003 年修订的出生证明格式。在研究的 10 年期间，有 27,044,217 次分娩符合纳入标准。5 个参数（包括既往剖宫产的产次、胎龄、分娩开始、胎儿位置和多胎）可在分娩时确定，用于将所有纳入的女性分为 10 组中的 1 组。
总的剖宫产率为 31.6%。第 3 组（单胎、足月、自然分娩的经产妇）的分娩最为常见，而第 5 组（既往剖宫产）的剖宫产分娩占比最高，从 2005 年至 2006 年的 27%增加到 2013 年至 2014 年的>34%。臀位妊娠（第 6 组和第 7 组）的剖宫产率>90%。初产妇和经产妇的产前剖宫产（第 2b 组和第 4b 组）占所有剖宫产分娩的四分之一以上。
有既往剖宫产史的女性代表了剖宫产分娩中比例不断增加的一部分。使用 Robson 标准可以对数据进行标准化比较，并确定导致剖宫产率变化的临床情况。医院和卫生组织可以使用 Robson 10 组分类系统评估与剖宫产相关的质量和流程。
