Echalard Julien, Vouga Manon, Bourtembourg-Matras Aude, Riethmuller Didier, Mottet Nicolas
Department of Obstetrics and Gynecology, University Hospital of Besancon, University of Franche-Comte, Pôle Mère-Femme, Alexander Fleming Boulevard, Besançon, 25000, France.
Department Femme-mère-enfant, Lausanne University Hospital, Lausanne, Switzerland.
Reprod Health. 2025 Jun 6;22(1):98. doi: 10.1186/s12978-025-02052-8.
Caesarean sections (CS) rates are constantly increasing. Despite being a life-saving procedure, this uncontrolled rise remains questionable. While international data suggest that increasing CS rates up to 10–15%, at the population level, is associated with a reduction of maternal and neonatal mortality, the benefit of higher CS rates remains debated.
The aim of this study was to describe trends of delivery by CS, using the Robson classification and to assess maternal and perinatal outcomes accordingly to identify potential strategies to control the rise in CS rates. This retrospective observational study included all births ≥ 22 weeks of gestation that occurred in a tertiary university hospital in Besançon, France, from January 1st, 2017, to December 31st, 2023. All deliveries were classified using Robson Ten Group Classification System (TGCS). Relative size, CS rate and contribution to the overall CS rate were described for each group. Secondary outcomes were rates of adverse maternal and perinatal outcomes.
A total of 19 082 women were included. The 7-year mean CS rate was 14.4% ( = 2753). A significant reduction of the overall CS rate from 15.4 to 13.0% (95% CI 0.5–4.2%) was observed between 2020 and 2023. This reduction was related to a significant reduction in overall CS rate among group 5 and an important trend towards reduction in group 6. The cesarean rate in group 1 remained stable over the period at 8% on average. During the study period, an increase in induction rates was observed. Maternal and perinatal outcomes were stable. A significant reduction of neonatal transfer was observed between 2020 and 2023 (1.4%; 95%CI 0.5-2.3%).
An average CS rate below 15% was achieved without increasing maternal and neonatal complications in a tertiary university hospital. Potential target interventions include a better management of women with a previous CS and breech deliveries.
The online version contains supplementary material available at 10.1186/s12978-025-02052-8.
剖宫产率持续上升。尽管剖宫产是一种挽救生命的手术，但这种不受控制的上升仍存在疑问。虽然国际数据表明，在人群层面将剖宫产率提高到10%-15%与降低孕产妇和新生儿死亡率相关，但更高剖宫产率的益处仍存在争议。
本研究的目的是使用罗布森分类法描述剖宫产分娩趋势，并据此评估孕产妇和围产期结局，以确定控制剖宫产率上升的潜在策略。这项回顾性观察研究纳入了2017年1月1日至2023年12月31日在法国贝桑松一家三级大学医院发生的所有妊娠≥22周的分娩。所有分娩均使用罗布森十组分类系统（TGCS）进行分类。描述了每组的相对规模、剖宫产率及其对总体剖宫产率的贡献。次要结局是孕产妇和围产期不良结局的发生率。
共纳入19082名女性。7年平均剖宫产率为14.4%（n=2753）。2020年至2023年期间，总体剖宫产率从15.4%显著降至13.0%（95%CI 0.5%-4.2%）。这种下降与第5组总体剖宫产率的显著下降以及第6组的重要下降趋势有关。第1组的剖宫产率在此期间保持稳定，平均为8%。在研究期间，引产率有所上升。孕产妇和围产期结局稳定。2020年至2023年期间，新生儿转运显著减少（1.4%；95%CI 0.5%-2.3%）。
在一家三级大学医院实现了平均剖宫产率低于15%，且未增加孕产妇和新生儿并发症。潜在的目标干预措施包括更好地管理有剖宫产史和臀位分娩的女性。
在线版本包含可在10.1186/s12978-025-02052-8获取的补充材料。
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