Department of Hospital Management and Clinical Services Excellence, Mashhad University of Medical Sciences, Mashhad, Iran.
Neonatal Health Office, Ministry of Health and Medical Education, Tehran, Iran.
BMC Pregnancy Childbirth. 2022 Mar 8;22(1):185. doi: 10.1186/s12884-022-04517-1.
The rise of Cesarean Sections (CS) is a global concern. In Iran, the rate of CS increased from 40.7% in 2005 to 53% in 2014. This figure is even higher in the private sector.
To analyze the CS rates in the last 2 years using the Robson Classification System in Iran.
A retrospective analysis of all in-hospital electronically recorded deliveries in Iran was conducted using the Robson classification. Comparisons were made in terms of the type of hospital, CS rate, and obstetric population, and contributions of each group to the overall cesarean deliveries were reported.
Two million three hundred twenty-two thousand five hundred women gave birth, 53.6% delivered through CS. Robson group 5 was the largest contributing group to the overall number of cesarean deliveries (47.1%) at a CS rate of 98.4%. Group 2 and 1 ranked the second and third largest contributing groups to overall CSs (20.6 and 10.8%, respectively). The latter groups had CS rates much higher than the WHO recommendation of 67.2 and 33.1%, respectively. "Fetal Distress" and "Undefined Indications" were the most common reasons for cesarean deliveries at CS rates of 13.6 and 13.4%, respectively. There was a significant variation in CS rate among the three types of hospitals for Robson groups 1, 2, 3, 4, and 10.
The study revealed significant variations in CS rate by hospital peer-group, especially for the private maternity units, suggesting the need for further attention and audit of the Robson groups that significantly influence the overall CS rate. The study results will help policymakers identify effective strategies to reduce the CS rate in Iran, providing appropriate benchmarking to compare obstetric care with other countries that have better maternal and perinatal outcomes.
剖宫产率的上升是一个全球性的问题。在伊朗，剖宫产率从 2005 年的 40.7%上升到 2014 年的 53%。这一数字在私营部门更高。
利用罗伯逊分类系统分析伊朗最近两年的剖宫产率。
对伊朗所有住院电子记录分娩病例进行回顾性分析，采用罗伯逊分类法进行分类。比较了医院类型、剖宫产率和产科人群，并报告了每组对总体剖宫产的贡献。
有 232.25 万名妇女分娩，53.6%的产妇行剖宫产术。罗伯逊分类第 5 组是对总体剖宫产分娩贡献最大的组（47.1%），剖宫产率为 98.4%。第 2 组和第 1 组分别排名第二和第三大剖宫产贡献组（分别为 20.6%和 10.8%）。这两组的剖宫产率远高于世界卫生组织建议的 67.2%和 33.1%。“胎儿窘迫”和“不明原因”是剖宫产率分别为 13.6%和 13.4%的最常见原因。罗伯逊第 1、2、3、4 和 10 组的剖宫产率在三种类型的医院之间存在显著差异。
该研究表明，医院同组间的剖宫产率存在显著差异，尤其是私立妇产医院，这表明需要进一步关注和审查对总体剖宫产率有显著影响的罗伯逊组。研究结果将有助于政策制定者确定有效策略，以降低伊朗的剖宫产率，为与其他母婴围产结局更好的国家进行产科护理提供适当的基准比较。
