Barnard-Mayers Ruby, Declercq Eugene, Murray Eleanor J, Yarrington Tina D, Werler Martha M
Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA (Barnard-Mayers, Murray, and Werler).
Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA (Declercq).
AJOG Glob Rep. 2025 Feb 24;5(2):100470. doi: 10.1016/j.xagr.2025.100470. eCollection 2025 May.
Cesarean delivery rates in the United States far exceed the World Health Organization (WHO)'s recommended population cesarean rate of 15%. This has resulted in calls from experts to reduce cesarean delivery rates. However, crude cesarean delivery rates are not necessarily comparable across populations since different birthing populations have different distributions of underlying cesarean delivery risk factors. WHO recommends using the Robson classification system to compare standardized cesarean delivery rates across populations, though it has been rarely used within the U.S.
The objectives of this study were to understand the distribution of cesarean deliveries using the Robson Classification system and to identify associated conditions (and potential drivers) of cesarean delivery across Robson groups.
Our data comes from the Pregnancy and Early Life Longitudinal Data System from the Massachusetts Department of Health, which contains all birth certificate records for Massachusetts from 2011 to 2018. Using the WHO Robson Classification System Implementation guide, we categorized births into one of its 10 categories based on data from birth certificate records and ICD-9 and ICD-10 codes from billing records. Using the linked birth certificate records and hospital discharge records we went beyond the Robson classifications and examined patterns in maternal comorbidities and labor and delivery complications of cesarean deliveries across Robson groups.
Among the 25% of birthing people who had singleton, term, vertex births with spontaneous labor, the cesarean delivery rate was 15% for nulliparous and 3% for multiparous (with no prior cesarean). The prevalence of maternal risk factors was 28% in the former and 30% in the latter. Labor and delivery complications were present in 46% and 35% of births, respectively. Birthing people with breech or transverse fetal presentation had the highest cesarean delivery rates around 95%. Multiparous birthing people with a prior cesarean delivery and cephalic, singleton, term births were the largest contributor to the cesarean delivery rate (38% of all cesareans). Almost all births for malpresentation or malposition of fetus had at least one labor and delivery complication but much lower rates of risk factors (between 25% and 46%).
While cesarean delivery rates, maternal risk factors, and labor and delivery complications followed similar patterns across Robson groups, there were notable discrepancies, especially in births with noncephalic presentations where maternal comorbidity rates matched lower cesarean-risk groups like the nulliparous single-term cephalic births.
美国的剖宫产率远远超过世界卫生组织（WHO）建议的15%的人群剖宫产率。这引发了专家们要求降低剖宫产率的呼声。然而，由于不同的分娩人群存在不同的潜在剖宫产风险因素分布，粗剖宫产率在不同人群之间不一定具有可比性。WHO建议使用罗布森分类系统来比较不同人群的标准化剖宫产率，不过该系统在美国很少被使用。
本研究的目的是了解使用罗布森分类系统的剖宫产分布情况，并确定罗布森分组中剖宫产的相关情况（以及潜在驱动因素）。
我们的数据来自马萨诸塞州卫生部的妊娠与早期生命纵向数据系统，该系统包含2011年至2018年马萨诸塞州所有的出生证明记录。根据出生证明记录数据以及计费记录中的ICD - 9和ICD - 10编码，我们使用WHO罗布森分类系统实施指南将分娩分为其10个类别之一。通过将出生证明记录与医院出院记录相链接，我们超越了罗布森分类，研究了罗布森分组中剖宫产产妇合并症以及分娩并发症的模式。
在25%的单胎、足月、头先露且自然分娩的产妇中，初产妇的剖宫产率为15%，经产妇（无既往剖宫产史）为3%。前者产妇风险因素的患病率为28%，后者为30%。分娩并发症分别出现在46%和35%的分娩中。臀位或横位胎儿的产妇剖宫产率最高，约为95%。有既往剖宫产史的经产妇以及头先露、单胎、足月分娩是剖宫产率的最大贡献者（占所有剖宫产的38%）。几乎所有胎位异常或胎儿位置不正的分娩至少有一项分娩并发症，但风险因素发生率要低得多（在25%至46%之间）。
虽然剖宫产率、产妇风险因素以及分娩并发症在罗布森分组中呈现出相似的模式，但也存在显著差异，尤其是在非头先露的分娩中，产妇合并症发生率与初产单胎足月头先露等低剖宫产风险组相当。
