Marian-Pavlenco Angela, Siritanu Irina, Ribac Tatiana, Friptu Valentin
Division of Obstetrics, Gynecology, and Human Reproduction, "Nicolae Testemitanu" State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.
AJOG Glob Rep. 2024 Oct 5;4(4):100408. doi: 10.1016/j.xagr.2024.100408. eCollection 2024 Nov.
The worldwide increase in the cesarean delivery rate is a major public health concern and cause of significant debate. Although multiple studies have shown that higher cesarean delivery rates may be associated with adverse maternal and perinatal outcomes, the number of cesarean deliveries has been continuously increasing. In the Republic of Moldova, cesarean delivery increased from 15.75% in 2012 to 27.42% in 2022. However, the perinatal mortality remained unchanged at 11.6%. To understand the factors that determine the increasing trend in cesarean delivery and to approach new strategies to reduce unnecessary surgical delivery, a standardized tool is needed to assess and compare cesarean delivery rates.
This study aimed to assess the changes in the rates and trends of cesarean delivery and to evaluate the contribution of different obstetrical populations to overall cesarean delivery rates in the Municipal Clinical Hospital using the Robson classification.
This was a cohort study conducted at the Municipal Clinical Hospital in Chisinau. The study included 13,882 women who gave birth in 2017, 2019, and 2022 at the Municipal Clinical Hospital. All births were classified into 10 Robson groups, using 6 basic variables (parity, cesarean delivery in medical history, labor onset, number of fetuses, gestational age, and fetal presentation). Statistical data were collected and analyzed using the Epi Info program (version 7.2.1.0; Centers for Disease Control and Prevention, Atlanta, GA).
The overall cesarean delivery rate was 20.02% (2779/13,882), with a significant increase from 18.59% (809/4351) to 21.59% (1134/5252) (=.0003). Approximately one-third (1099/2279 [39.55%]) of all cesarean deliveries were performed before labor onset. The main contributor in all study years was group 5 (957/2779 [34.44%]). The next valuable group that contributed to the overall cesarean delivery rate was group 2 (393/2779 [14.14%]), followed by group 1 (333/2779 [11.98%]).
The Robson Ten-Group Classification System provides a clear and detailed record of the trends in cesarean delivery. In addition, because of the Robson Ten-Group Classification System's simplicity and exclusivity, it can be implemented in the Republic of Moldova. The main contributors to the overall cesarean delivery rate were women with a previous cesarean delivery (group 5), followed by nulliparous women of group 2 and group 1.
全球剖宫产率的上升是一个重大的公共卫生问题，引发了激烈的争论。尽管多项研究表明，较高的剖宫产率可能与孕产妇和围产期不良结局相关，但剖宫产的数量仍在持续增加。在摩尔多瓦共和国，剖宫产率从2012年的15.75%上升到2022年的27.42%。然而，围产期死亡率保持在11.6%不变。为了了解决定剖宫产上升趋势的因素，并探索减少不必要手术分娩的新策略，需要一种标准化工具来评估和比较剖宫产率。
本研究旨在使用罗布森分类法评估剖宫产率的变化和趋势，并评估不同产科人群对市立临床医院总体剖宫产率的贡献。
这是一项在基希讷乌市立临床医院进行的队列研究。该研究纳入了2017年、2019年和2022年在市立临床医院分娩的13882名妇女。所有分娩均使用6个基本变量（产次、既往剖宫产史、临产、胎儿数量、孕周和胎位）分为10个罗布森组。使用Epi Info程序（版本7.2.1.0；美国疾病控制与预防中心，佐治亚州亚特兰大）收集和分析统计数据。
总体剖宫产率为20.02%（2779/13882），从18.59%（809/4351）显著上升至21.59%（1134/5252）（P =.0003）。所有剖宫产中约三分之一（1099/2279 [39.55%]）在临产前行剖宫产。所有研究年份中主要贡献组为第5组（957/2779 [34.44%]）。对总体剖宫产率有贡献的下一个重要组是第2组（393/2779 [14.14%]），其次是第1组（333/2779 [11.98%]）。
罗布森十组分类系统提供了剖宫产趋势的清晰详细记录。此外，由于罗布森十组分类系统的简单性和独特性，它可以在摩尔多瓦共和国实施。总体剖宫产率的主要贡献者是有剖宫产史的妇女（第5组），其次是第2组和第1组的初产妇。
