Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, Poissy, France.
EA 7285, Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France.
PLoS One. 2021 Aug 20;16(8):e0251141. doi: 10.1371/journal.pone.0251141. eCollection 2021.
WHO has recommended using Robson's Ten Group Classification System (TGCS) to monitor and analyze CD rates. Its failure to take some maternal and organizational factors into account, however, could limit the interpretation of CD rate comparisons, because it may contribute to variations in hospital CD rates.
To study the contribution of maternal socioeconomic and clinical characteristics and hospital organizational factors to the variation in CD rates when using Robson's ten-group classification system for CD rate comparisons.
This prospective, observational, population-based study included all deliveries at a gestational age > 24 weeks at the 10 hospitals of the French MYPA perinatal network in the Paris area. CD rates were calculated for each TGCS group in each hospital. Interhospital variations in these rates were investigated with hierarchical logistic regression models to quantify the variation explained by differences in patient and hospital characteristics when the TGCS is considered. Variations in CD rates between hospitals were estimated with median odds ratios (MOR) to express interhospital variance on the standard odds ratio scale. The percentage of variation explained by TGCS and maternal and hospital characteristics was also calculated.
The global CD rate was 24.0% (interhospital range: 17-32%). CD rates within each TGCS group differed significantly between hospitals (P<0.001). CD was significantly associated with maternal age (>40 years), severe preeclampsia, and two organizational factors: hospital status (private maternities) and the deliveries per staff member per 24 hours. The MOR in the empty model was 1.27 and did not change after taking the TGCS into account. Adding maternal characteristics and hospital organizational factors lowered the MOR to 1.14 and reduced the variation between hospital CD rates by 70%.
Maternal characteristics and hospital factors are needed to address variation in CD rates among the TGCS groups. Therefore, comparisons of these rates that do not consider these factors should be interpreted carefully.
世界卫生组织（WHO）推荐使用 Robson 的十组分类系统（TGCS）来监测和分析剖宫产率。然而，由于它没有考虑到一些产妇和组织因素，这可能会限制对剖宫产率比较的解释，因为它可能导致医院剖宫产率的变化。
研究产妇社会经济和临床特征以及医院组织因素对使用 Robson 的十组分类系统进行剖宫产率比较时剖宫产率变化的贡献。
这是一项前瞻性、观察性、基于人群的研究，包括巴黎地区法国 MYPA 围产期网络的 10 家医院所有妊娠 24 周以上的分娩。在每个医院的每个 TGCS 组中计算剖宫产率。使用分层逻辑回归模型研究这些率的医院间差异，以量化当考虑 TGCS 时，患者和医院特征差异解释的差异。使用中位数优势比（MOR）估计医院间剖宫产率的差异，以标准优势比的尺度表示医院间的方差。还计算了 TGCS 和产妇及医院特征解释的变异百分比。
全球剖宫产率为 24.0%（医院间范围：17-32%）。每个 TGCS 组内的剖宫产率在医院之间差异显著（P<0.001）。剖宫产与产妇年龄（>40 岁）、严重子痫前期以及两个组织因素显著相关：医院地位（私立产科）和每 24 小时每员工的分娩次数。空模型中的 MOR 为 1.27，在考虑 TGCS 后没有改变。加入产妇特征和医院组织因素后，MOR 降低至 1.14，并降低了医院间剖宫产率的差异 70%。
需要考虑产妇特征和医院因素来解决 TGCS 组之间的剖宫产率差异。因此，不考虑这些因素的这些率的比较应该仔细解释。
