Eftekharian Christabel, Husslein Peter Wolf, Lehner Rainer
Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.
Matern Child Health J. 2021 Sep;25(9):1474-1481. doi: 10.1007/s10995-021-03183-7. Epub 2021 Jun 28.
The cesarean delivery (CD) rate is increasing worldwide. An internationally recognized classification system had been required to analyse the trend and its possible consequences in a standardized manner. The goal of this study was to identify the main contributors to the CD rate at the Medical University of Vienna in an 11-year time period (2003-2013) and to analyse neonatal outcome parameters within the ten Robson categories.
This is a retrospective data-analysis of singleton and twin pregnancies in cephalic, breech and transverse presentation with a gestational age between 23 and 42 weeks. The cases were divided into ten classes based on the Robson criteria. CD rates and perinatal outcome parameters were analysed within each Robson class. The outcome parameters included: NICU-admission rate and 5 min Apgar score values < 7.
The overall CD rate was at 44.2%. Within Robson class 5 the CD rate was the highest at 99.1%. Main contributors were Robson class 5 at 20.6%, followed by class 2 at 17.1% and class 8 at 15.0%. Neonatal outcome analyses revealed significant differences between the Robson classes.
The main contributors to the CD rate were determined. We suggest reconsidering the frequently applied birth mode especially for Robson class 2, 4, 5 and 8. Lowering the CD rate could be achievable, if a careful delivery management and an individual risk evaluation is provided. It is important to reduce the CD rate in the individual Robson classes under consideration of perinatal outcome parameters, since a reduction should only take place where it is clinically useful and relevant.
剖宫产率在全球范围内呈上升趋势。需要一个国际认可的分类系统来以标准化方式分析这一趋势及其可能产生的后果。本研究的目的是确定维也纳医科大学在11年期间（2003 - 2013年）剖宫产率的主要影响因素，并分析十个罗布森分类中的新生儿结局参数。
这是一项对单胎和双胎妊娠的回顾性数据分析，妊娠孕周为23至42周，胎位为头位、臀位和横位。根据罗布森标准将病例分为十类。在每个罗布森分类中分析剖宫产率和围产期结局参数。结局参数包括：新生儿重症监护病房（NICU）入住率和5分钟阿氏评分<7分。
总体剖宫产率为44.2%。在罗布森分类5中，剖宫产率最高，为99.1%。主要影响因素是罗布森分类5，占20.6%，其次是分类2，占17.1%，分类8，占15.0%。新生儿结局分析显示罗布森分类之间存在显著差异。
确定了剖宫产率的主要影响因素。我们建议重新考虑经常采用的分娩方式，特别是对于罗布森分类2、4、5和8。如果提供仔细的分娩管理和个体风险评估，降低剖宫产率是可以实现的。在考虑围产期结局参数的情况下，降低各个罗布森分类中的剖宫产率很重要，因为只有在临床有用且相关的情况下才应进行降低。
