Nopparat Rajathanee Hospital, Ministry of Public Health, Bangkok, Thailand.
Influenza Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Ministry of Public Health (DDC building 7), Tiwanon Road, Nonthaburi, 11000, Thailand.
BMC Pregnancy Childbirth. 2024 Feb 21;24(1):149. doi: 10.1186/s12884-024-06314-4.
Cesarean delivery rates have increased globally resulting in a public health concern. We estimate rates of cesarean deliveries among Thai women using the World Health Organization (WHO) Robson Classification system and compare rates by Robson group to the Robson guideline for acceptable rates to identify groups that might benefit most from interventions for rate reduction.
In 2017 and 2018, we established cohorts of pregnant women aged ≥ 18 years seeking prenatal care at two tertiary Thai hospitals and followed them until 6-8 weeks postpartum. Three in-person interviews (enrollment, end of pregnancy, and postpartum) were conducted using structured questionnaires to obtain demographic characteristics, health history, and delivery information. Cesarean delivery indication was classified based on core obstetric variables (parity, previous cesarean delivery, number of fetuses, fetal presentation, gestational week, and onset of labor) assigned to 10 groups according to the Robson Classification. Logistic regression was used to identify factors associated with cesarean delivery among nulliparous women with singleton, cephalic, term pregnancies.
Of 2,137 participants, 970 (45%) had cesarean deliveries. The median maternal age at delivery was 29 years (interquartile range, 25-35); 271 (13%) participants had existing medical conditions; and 446 (21%) had pregnancy complications. The cesarean delivery rate varied by Robson group. Multiparous women with > 1 previous uterine scar, with a single cephalic pregnancy, ≥ 37 weeks gestation (group 5) contributed the most (14%) to the overall cesarean rate, whereas those with a single pregnancy with a transverse or oblique lie, including women with previous uterine scars (group 9) contributed the least (< 1%). Factors independently associated with cesarean delivery included age ≥ 25 years, pre-pregnancy obesity, new/worsen medical condition during pregnancy, fetal distress, abnormal labor, infant size for gestational age ≥ 50 percentiles, and self-pay for delivery fees. Women with existing blood conditions were less likely to have cesarean delivery.
Almost one in two pregnancies among women in our cohorts resulted in cesarean deliveries. Compared to WHO guidelines, cesarean delivery rates were elevated in selected Robson groups indicating that tailored interventions to minimize non-clinically indicated cesarean delivery for specific groups of pregnancies may be warranted.
剖宫产率在全球范围内呈上升趋势，这是一个公共卫生问题。我们使用世界卫生组织（WHO）罗伯逊分类系统估计泰国妇女的剖宫产率，并按罗伯逊组与可接受率的罗伯逊指南进行比较，以确定最有可能从降低剖宫产率干预措施中受益的人群。
2017 年和 2018 年，我们在两家泰国三级医院建立了年龄≥18 岁的孕妇队列，并在产后 6-8 周对其进行随访。通过结构化问卷进行了三次面对面访谈（入组、妊娠结束和产后），以获取人口统计学特征、健康史和分娩信息。剖宫产术指征根据核心产科变量（产次、既往剖宫产术、胎儿数、胎儿位置、孕周和临产开始）进行分类，根据罗伯逊分类系统将这些变量分为 10 组。使用逻辑回归分析确定初产妇中与剖宫产术相关的因素，这些初产妇为单胎、头位、足月妊娠。
在 2137 名参与者中，有 970 名（45%）行剖宫产术。产妇分娩时的中位年龄为 29 岁（四分位间距 25-35 岁）；271 名（13%）参与者有现有医疗条件；446 名（21%）有妊娠并发症。罗伯逊组的剖宫产率有所不同。有>1 次子宫瘢痕的多产妇，单胎头位，≥37 孕周（第 5 组）对总剖宫产率的贡献最大（14%），而单胎横位或斜位，包括有既往子宫瘢痕的产妇（第 9 组）的贡献最小（<1%）。与剖宫产术独立相关的因素包括年龄≥25 岁、孕前肥胖、妊娠期间新出现/恶化的医疗状况、胎儿窘迫、异常产程、胎儿大小与胎龄≥50%相比、以及自行支付分娩费用。有现有血液状况的妇女发生剖宫产的可能性较小。
我们队列中近一半的孕妇分娩需要剖宫产。与世界卫生组织的指南相比，选定的罗伯逊组的剖宫产率升高，这表明可能需要针对特定妊娠人群量身定制干预措施，以尽量减少非临床指征的剖宫产术。
