Aura Pyykönen1,2, Mika Gissler3,4, Ellen Løkkegaard5,6, Thomas Bergholt5,7, Steen C Rasmussen5,7, Alexander Smárason8,9, Ragnheiður I Bjarnadóttir8,9,10, Birna B Másdóttir10, Karin Källén11,12, Kari Klungsoyr13,14, Susanne Albrechtsen14,15, Finn E Skjeldestad16, Anna-Maija Tapper1,17. 1. University of Helsinki, Helsinki, Finland. 2. Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland. 3. National Institute for Health and Welfare THL, Helsinki, Finland. 4. Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden. 5. University of Copenhagen, Copenhagen, Denmark. 6. Department of Obstetrics and Gynecology, Nordsjaelland Hospital, Hillerod, Denmark. 7. Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark. 8. The Icelandic Birth Registry, Akureyri, Iceland. 9. Institute of Health Science Research, University of Akureyri, Akureyri, Iceland. 10. Landspitali University Hospital, Reykajvik, Iceland. 11. Swedish National Board of Health and Welfare, Stockholm, Sweden. 12. University of Lund, Lund, Sweden. 13. Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway. 14. Department of Clinical Science, University of Bergen, Bergen, Norway. 15. Haukeland University Hospital, Bergen, Norway. 16. Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway. 17. Hyvinkää Hospital, Hyvinkää, Finland.
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 (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.
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.
Authors: Viktor H Ahlqvist; Margareta Persson; Francisco B Ortega; Per Tynelius; Cecilia Magnusson; Daniel Berglind Journal: Sci Rep Date: 2019-07-04 Impact factor: 4.379
Authors: Garazi Carrillo-Aguirre; Albert Dalmau-Bueno; Carlos Campillo-Artero; Anna García-Altés Journal: PLoS One Date: 2020-06-16 Impact factor: 3.240