通过 Robson 分类改善剖宫产决策：基于 5323500 例活产数据的一项基于人群的研究。
Improving the Caesarean Decision by Robson Classification: A Population-Based Study by 5,323,500 Livebirth Data.
机构信息
Science and Letter Faculty, Molecular Biology and Genetics Department, Istanbul Technical University, TR.
Healthcare Services Department, Gynecology and Obstetrics Specialist, Public Hospital Directorate, TR.
出版信息
Ann Glob Health. 2020 Aug 17;86(1):101. doi: 10.5334/aogh.2615.
BACKGROUND
Caesarean section is a major obstetric intervention for saving lives of women and their newborns from pregnancy- and childbirth-related complications. C-Section rate is considered an important indicator for measuring obstetric services in any country, region, or institution. In many countries, based on population, all-cause C-Section rates have increased steadily during the past half century. The high and rising C-Section rate is certainly a cause for concern, and evidence-based information is needed as to how or why the C-Section rate has increased and what needs to be done. In this study, we tried to demonstrate how the Robson Classification can be used as a common starting point to audit caesarean deliveries.
OBJECTIVES
Given the lack of a scientifically proven classification system to observe and compare caesarean rates, the WHO proposes adopting the Robson's criteria-related grouping as an internationally applicable C-Section classification system.
METHODS
We conducted a retrospective study to look into the relation of Robson Criteria and C-Section. Our four years of study encompass 5,323,500 livebirths in Turkey and provide an important source of information for evaluating statistical data.
FINDINGS
We analysed pregnancies according to the percentage of live births in Robson's groups and the caesarean rate within the Robson's groups. In total, 2,764,373 pregnant women have undergone caesarean over 4 years with a 51.9% C-Section rate. According to our findings, as time progresses, the R5 group are expanding due to the caesarean sections groups R1-R4.The R5 group C-Section rate increased regularly from 22.2% in 2013 to 24.3% in 2016. Caesarean sections performed in R1-R4 groups cause subsequent pregnancies of these women to result in caesarean section.
CONCLUSIONS
Our results suggest the Robson classification system will help in analysing, screening, auditing, and comparing caesarean rates across different hospitals, countries, or regions and will help to create and implement effective strategies specifically to reach WHO recommended C-Section rates.
背景
剖宫产术是挽救因妊娠和分娩相关并发症而危及生命的母婴的主要产科干预措施。剖宫产率被认为是衡量任何国家、地区或机构产科服务的一个重要指标。在许多国家，基于人口，半个世纪以来，所有原因的剖宫产率一直在稳步上升。如此高且不断上升的剖宫产率肯定令人担忧，需要有基于证据的信息来了解剖宫产率为何增加以及需要做些什么。在这项研究中，我们试图展示如何将 Robson 分类作为审核剖宫产的共同起点。
目的
鉴于缺乏经过科学验证的分类系统来观察和比较剖宫产率，世卫组织建议采用 Robson 标准相关分组作为一种国际适用的剖宫产分类系统。
方法
我们进行了一项回顾性研究，以研究 Robson 标准与剖宫产之间的关系。我们的四年研究涵盖了土耳其的 5323500 例活产，为评估统计数据提供了重要信息来源。
结果
我们根据 Robson 组中活产的百分比以及 Robson 组内的剖宫产率对妊娠进行了分析。在四年中，共有 2764373 名孕妇接受了剖宫产，剖宫产率为 51.9%。根据我们的发现，随着时间的推移，由于 R1-R4 剖宫产组，R5 组不断扩大。R5 组的剖宫产率从 2013 年的 22.2%稳步上升到 2016 年的 24.3%。R1-R4 组进行的剖宫产导致这些妇女随后的妊娠也以剖宫产结束。
结论
我们的结果表明，Robson 分类系统将有助于分析、筛选、审核和比较不同医院、国家或地区的剖宫产率，并有助于制定和实施专门针对实现世卫组织推荐的剖宫产率的有效策略。
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