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Cesarean section trends in the Nordic Countries - a comparative analysis with the Robson classification

Pyykönen, Aura; Gissler, Mika; Løkkegaard, Ellen; Bergholt, Thomas; Rasmussen, Steen C.; Smárason, Alexander; Bjarnadóttir, Ragnheiur I.; Másdóttir, Birna B.; Källén, Karin LU and Klungsoyr, Kari, et al. (2017) In Acta Obstetricia et Gynecologica Scandinavica 96(5). p.607-616
Abstract

Introduction: The cesarean rates are low but increasing in most Nordic countries. Using the Robson classification, we analyzed which obstetric groups have contributed to the changes in the cesarean rates. Material and methods: Retrospective population-based registry study including all deliveries (3 398 586) between 2000 and 2011 in Denmark, Finland, Iceland, Norway and Sweden. The Robson group distribution, cesarean rate and contribution of each Robson group were analyzed nationally for four 3-year time periods. For each country, we analyzed which groups contributed to the change in the total cesarean rate. Results: Between the first and the last time period studied, the total cesarean rates increased in Denmark (16.4 to 20.7%), Norway... (More)

Introduction: The cesarean rates are low but increasing in most Nordic countries. Using the Robson classification, we analyzed which obstetric groups have contributed to the changes in the cesarean rates. Material and methods: Retrospective population-based registry study including all deliveries (3 398 586) between 2000 and 2011 in Denmark, Finland, Iceland, Norway and Sweden. The Robson group distribution, cesarean rate and contribution of each Robson group were analyzed nationally for four 3-year time periods. For each country, we analyzed which groups contributed to the change in the total cesarean rate. Results: Between the first and the last time period studied, the total cesarean rates increased in Denmark (16.4 to 20.7%), Norway (14.4 to 16.5%) and Sweden (15.5 to 17.1%), but towards the end of our study, the cesarean rates stabilized or even decreased. The increase was explained mainly by increases in the absolute contribution from R5 (women with previous cesarean) and R2a (induced labor on nulliparous). In Finland, the cesarean rate decreased slightly (16.5 to 16.2%) mainly due to decrease among R5 and R6-R7 (breech presentation, nulliparous/multiparous). In Iceland, the cesarean rate decreased in all parturient groups (17.6 to 15.3%), most essentially among nulliparous women despite the increased induction rates. Conclusions: The increased total cesarean rates in the Nordic countries are explained by increased cesarean rates among nulliparous women, and by an increased percentage of women with previous cesarean. Meanwhile, induction rates on nulliparous increased significantly, but the impact on the total cesarean rate was unclear. The Robson classification facilitates benchmarking and targeting efforts for lowering the cesarean rates.

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published
subject
keywords
Cesarean section, Delivery, Induction of labor, Robson classification, Uterine scar
in
Acta Obstetricia et Gynecologica Scandinavica
volume
96
issue
5
pages
607 - 616
publisher
Wiley-Blackwell
external identifiers
  • scopus:85016403859
  • wos:000399891200013
ISSN
0001-6349
DOI
10.1111/aogs.13108
language
English
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yes
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922a9539-de62-48b2-a418-036d35982c24
date added to LUP
2017-04-19 11:31:45
date last changed
2017-09-18 13:32:38
@article{922a9539-de62-48b2-a418-036d35982c24,
  abstract     = {<p>Introduction: The cesarean rates are low but increasing in most Nordic countries. Using the Robson classification, we analyzed which obstetric groups have contributed to the changes in the cesarean rates. Material and methods: Retrospective population-based registry study including all deliveries (3 398 586) between 2000 and 2011 in Denmark, Finland, Iceland, Norway and Sweden. The Robson group distribution, cesarean rate and contribution of each Robson group were analyzed nationally for four 3-year time periods. For each country, we analyzed which groups contributed to the change in the total cesarean rate. Results: Between the first and the last time period studied, the total cesarean rates increased in Denmark (16.4 to 20.7%), Norway (14.4 to 16.5%) and Sweden (15.5 to 17.1%), but towards the end of our study, the cesarean rates stabilized or even decreased. The increase was explained mainly by increases in the absolute contribution from R5 (women with previous cesarean) and R2a (induced labor on nulliparous). In Finland, the cesarean rate decreased slightly (16.5 to 16.2%) mainly due to decrease among R5 and R6-R7 (breech presentation, nulliparous/multiparous). In Iceland, the cesarean rate decreased in all parturient groups (17.6 to 15.3%), most essentially among nulliparous women despite the increased induction rates. Conclusions: The increased total cesarean rates in the Nordic countries are explained by increased cesarean rates among nulliparous women, and by an increased percentage of women with previous cesarean. Meanwhile, induction rates on nulliparous increased significantly, but the impact on the total cesarean rate was unclear. The Robson classification facilitates benchmarking and targeting efforts for lowering the cesarean rates.</p>},
  author       = {Pyykönen, Aura and Gissler, Mika and Løkkegaard, Ellen and Bergholt, Thomas and Rasmussen, Steen C. and Smárason, Alexander and Bjarnadóttir, Ragnheiur I. and Másdóttir, Birna B. and Källén, Karin and Klungsoyr, Kari and Albrechtsen, Susanne and Skjeldestad, Finn Egil and Tapper, Anna-Maija},
  issn         = {0001-6349},
  keyword      = {Cesarean section,Delivery,Induction of labor,Robson classification,Uterine scar},
  language     = {eng},
  month        = {03},
  number       = {5},
  pages        = {607--616},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Obstetricia et Gynecologica Scandinavica},
  title        = {Cesarean section trends in the Nordic Countries - a comparative analysis with the Robson classification},
  url          = {http://dx.doi.org/10.1111/aogs.13108},
  volume       = {96},
  year         = {2017},
}