El Radaf Viktoria, Campos Letícia Nunes, Savona-Ventura Charles, Mahmood Tahir, Zaigham Mehreen
Department of Obstetrics and Gynaecology, Lasarettet i Ystad, Ystad, Sweden.
Faculty of Medical Sciences, Universidade de Pernambuco, Recife, Brazil.
Eur J Obstet Gynecol Reprod Biol. 2025 Feb;305:178-198. doi: 10.1016/j.ejogrb.2024.11.052. Epub 2024 Dec 4.
The aim of this systemic review and meta-analysis was to examine the differences in caesarean section rates across European regions and at a country level by utilizing the Robson classification system. The study has compared caesarean rates across European regions using the Robson classification to identify the drivers of caesarean section use. This review shows significant variations in caesarean section rates across European regions, ranging from 16.9 % in Northern Europe to 43.6 % in Southern Europe. There was a higher contribution of previous CS (Robson Group 5), ranging from 51.2 to 95.0 % of CS in this group to overall rates, particularly in Southern Europe (95.0 %), raises concerns about the "domino effect" of primary caesareans. This finding emphasises the critical importance of strategies to reduce primary CS rates.
Caesarean section (CS) rates exhibit considerable global variation, reflecting diverse medical practices, cultural attitudes, and healthcare policies. While some regions maintain relatively low rates, others report significantly higher incidences of the procedure. Analysing these differences is crucial for understanding and developing targeted healthcare strategies and ensuring optimal maternal and neonatal outcomes. This review examines differences in CS rates in Europe according to the Robson 10 group classification.
We identified articles between January 2000 to June 2023 using MEDLINE/PubMed, CINAHL, EMBASE, Global Index Medicus, Web of Science and Cochrane library. There was no restriction on patient population, except for birth in a country of the European region. We excluded all studies that were conference proceedings and studies reported in a language other than English and Swedish.
The search generated a total of 1024 studies, out of which 44 were included, encompassing 6,641,615 births. The majority were from Northern (38 %) and Western Europe (33.5 %). CS rates varied markedly across Europe, ranging from 16.9 % in Northern region to 43.6 % in Southern Europe. The highest contribution to CS rates came from Robson Group 5 (previous CS), with contributions ranging from 51.2 % in Northern to 95.0 % in Southern Europe. The mode of birth for Robson Group 6 (nulliparous, breech) was predominately by CS (88.8 % in Northern to 92.5 % in Central-Eastern Europe).
CS rates continue to vary widely across Europe, with the highest rates in Southern and the lowest in Northern Europe. Previous CS and breech presentation were prominent drivers of CS rates. Region-specific strategies are needed to address these diverse factors to minimise accelerating CS rates across Europe.
本系统评价和荟萃分析的目的是利用罗布森分类系统，研究欧洲各地区以及国家层面剖宫产率的差异。该研究通过罗布森分类比较了欧洲各地区的剖宫产率，以确定剖宫产使用的驱动因素。本评价显示，欧洲各地区的剖宫产率存在显著差异，从北欧的16.9%到南欧的43.6%不等。既往剖宫产（罗布森第5组）的贡献率较高，该组剖宫产在总剖宫产率中的占比从51.2%到95.0%不等，在南欧尤为突出（95.0%），这引发了对首次剖宫产“多米诺效应”的担忧。这一发现强调了降低首次剖宫产率策略的至关重要性。
剖宫产率在全球范围内存在显著差异，反映了不同的医疗实践、文化观念和医疗保健政策。虽然一些地区的剖宫产率相对较低，但其他地区的该手术发生率则显著较高。分析这些差异对于理解和制定有针对性的医疗保健策略以及确保最佳的母婴结局至关重要。本评价根据罗布森10组分类研究了欧洲剖宫产率的差异。
我们使用MEDLINE/PubMed、CINAHL、EMBASE、全球医学索引、科学网和考克兰图书馆，检索了2000年1月至2023年6月期间的文章。除了在欧洲地区国家出生的患者外，对患者人群没有限制。我们排除了所有会议论文以及非英语和瑞典语报道的研究。
检索共获得1024项研究，其中44项被纳入，涵盖6641615例分娩。大多数研究来自北欧（38%）和西欧（33.5%）。欧洲各地的剖宫产率差异显著，从北部地区的16.9%到南欧的43.6%不等。剖宫产率的最高贡献来自罗布森第5组（既往剖宫产），贡献率从北欧的51.2%到南欧的95.0%不等。罗布森第6组（初产妇，臀位）的分娩方式主要为剖宫产（北欧为88.8%，中东欧为92.5%）。
欧洲各地的剖宫产率仍然差异很大，南欧最高，北欧最低。既往剖宫产和臀位是剖宫产率的主要驱动因素。需要针对不同地区制定策略来应对这些多样的因素，以尽量减少欧洲剖宫产率的加速上升。
