Prüst Zita D, Dupont Josephine A I, Liesdek Safir, Bloemenkamp Kitty W M, van den Akker Thomas, Verschueren Kim J C, Kodan Lachmi R
Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina's Children Hospital, University Medical Centre Utrecht, Utrecht University, UMC Utrecht, 3508 AB, Utrecht, Postbus 85090, the Netherlands.
Department of Obstetrics and Gynaecology, Academic Hospital Paramaribo (AZP), Afdeling Verloskunde, Flustraat 2, Paramaribo, Suriname.
BMC Pregnancy Childbirth. 2025 Jan 20;25(1):46. doi: 10.1186/s12884-024-07009-6.
Optimizing CS performance is a global health priority, given the maternal and perinatal morbidity and mortality associated with both underuse and overuse. This study aims to (1) determine the facility-based CS rate in Suriname and explore which women are most likely to undergo a CS and (2) classify all CS by the WHO Robson classification and analyze the perinatal outcomes.
An observational, cross-sectional study in Suriname, using nationwide birth registry data that included all hospital births in 2020 and 2021 (≥ 27 weeks of gestation). We used multivariate logistic regression analysis to assess maternal and perinatal characteristics associated with CS. We described cesarean births according to the Robson-10 classification and used descriptive statistics to analyze CS frequencies and perinatal outcomes.
We analyzed the 18,917 women who gave birth in Surinamese hospitals, with an overall 23.9% CS rate (n = 4522/18,917). The highest CS rates were seen among women with a previous CS (69.3%, aOR 16.2, 95% CI 14.4-18.2), BMI > 40 (47.0%, aOR 5.1, 95% CI 4.0-6.5), newborn with a birthweight from or above 4,000 g (37.3%, 2.2, 95% CI 1.6-3.0) and women giving birth at hospital IV (38.5%, aOR 1.8, 95% CI 1.6-2.0). Hindustani women were more likely to give birth by CS compared to Maroon women (aOR 1.6, 95% CI 1.4-2.0). The largest contribution to the overall CS rate was Robson group 5 (i.e. multiparous women with a previous CS and a singleton term pregnancy in cephalic presentation, 30.5%, n = 1,378). Robson group 2 and 4 (i.e. pre-labor CS, or CS after induction, among term women without previous CS and cephalic presentation) contributed to 21.8% (n = 985) of all CS performed. Robson group 1 and 3 (i.e. during spontaneous labor CS among term women without previous CS and cephalic presentation) accounted for 23.3% (n = 1,052) of all CS cases.
The facility-based CS rate in Suriname is 24%, with substantial intra-country and inter-hospital variations. These disparities underscore the need for targeted interventions addressing both overuse and underuse of CS. Preventative measures should prioritize promoting safe VBAC, increasing assisted vaginal birth, preventing first-time CS and ongoing monitoring of trends and regular case audits.
鉴于剖宫产（CS）使用不足和过度使用均会导致孕产妇及围产期发病和死亡，优化剖宫产表现是一项全球卫生重点工作。本研究旨在：（1）确定苏里南基于机构的剖宫产率，并探究哪些女性最有可能接受剖宫产；（2）根据世界卫生组织（WHO）罗布森分类法对所有剖宫产进行分类，并分析围产期结局。
在苏里南开展一项观察性横断面研究，使用全国范围的出生登记数据，这些数据涵盖2020年和2021年所有医院分娩（妊娠≥27周）。我们采用多变量逻辑回归分析来评估与剖宫产相关的孕产妇和围产期特征。我们根据罗布森-10分类法描述剖宫产分娩情况，并使用描述性统计分析剖宫产频率和围产期结局。
我们分析了在苏里南医院分娩的18917名女性，总体剖宫产率为23.9%（n = 4522/18917）。既往有剖宫产史的女性剖宫产率最高（69.3%，调整后比值比[aOR] 16.2，95%置信区间[CI] 14.4 - 18.2），体重指数（BMI）> 40的女性（47.0%，aOR 5.1，95% CI 4.0 - 6.5），出生体重≥4000g的新生儿的母亲（37.3%，aOR 2.2，95% CI 1.6 - 3.0）以及在第四医院分娩的女性（38.5%，aOR 1.8，95% CI 1.6 - 2.0）。与褐种女性相比，印度斯坦女性更有可能通过剖宫产分娩（aOR 1.6，95% CI 1.4 - 2.0）。对总体剖宫产率贡献最大的是罗布森第5组（即既往有剖宫产史、单胎足月妊娠且头先露的经产妇，30.5%，n = 1378）。罗布森第2组和第4组（即足月且无既往剖宫产史、头先露的产妇临产前剖宫产或引产术后剖宫产）占所有剖宫产的21.8%（n = 985）。罗布森第1组和第3组（即足月且无既往剖宫产史、头先露的产妇自然分娩过程中的剖宫产）占所有剖宫产病例的23.3%（n = 1052）。
苏里南基于机构的剖宫产率为24%，国内及医院间存在显著差异。这些差异凸显了针对剖宫产过度使用和使用不足采取针对性干预措施的必要性。预防措施应优先促进安全的剖宫产后阴道分娩（VBAC）、增加阴道助产、预防首次剖宫产以及持续监测趋势和定期进行病例审核。
