ABSTRACT
Objectives
To assess the rate of cesarean delivery at Basurto University Hospital (Bilbao, Spain)
between 2015 and 2017 and to determine the cause of an increase in this rate during
2017.
Methods
We retrospectively reviewed 6975 deliveries between 2015 and 2017, classifying women
using the Robson classification. We analyzed extended perinatal mortality and perinatal
outcomes during the study period and performed a comparative analysis of cesarean
deliveries by year and Robson group. Comparisons were made with analysis of variance
and χ2 or Fisher's exact tests.
Results
During the study period, 928 cesarean deliveries (13.3%) were performed. Extended
perinatal mortality in this period was 7.0%. We detected an increase in the rate of
cesarean delivery in 2017 in Group 1 women (P = 0.0224), with significant differences in the homogeneity of the distribution of
cesarean deliveries performed for fetal distress between years in this group (P = 0.0093). Auditing the cases of cesareans performed for fetal distress in Group
1 in 2017, we found that the indication was appropriate in all cases, but in 39.4%,
the management of uterine contractions during labour was considered suboptimal.
Conclusion
Classifying cesarean deliveries using the Robson classification allows us to compare
cesarean rates in different years and analyze any increases in these rates. Increases
are sometimes attributed to changes in the obstetric population, but when investigated
may be found to be related to potentially correctable problems. It is not necessary
to have a high rate of cesarean delivery to warrant internal audit.
RÉSUMÉ
Objectifs
Évaluer le taux de césariennes à l'hôpital universitaire de Basurto (Bilbao, Espagne)
pour la période de 2015 à 2017, et déterminer la cause de l'augmentation de ce taux
en 2017.
Méthodologie
Nous avons rétrospectivement évalué 6 975 accouchements pour la période de 2015 à 2017
en catégorisant les femmes au moyen de la classification de Robson. Nous avons analysé
le taux de mortalité périnatale étendue et les issues périnatales pour la période
à l’étude, puis nous avons effectué une analyse comparative des césariennes d'après
l'année de l'accouchement et le groupe de classification de Robson. Les comparaisons
ont été effectuées au moyen de l'analyse de la variance et le test du χ2 ou le test exact de Fisher.
Résultats
Pendant la période à l’étude, 928 césariennes (13,3 %) ont été réalisées. Le taux
de mortalité périnatale étendue pour cette période était de 7,0 ‰. Nous avons observé
une augmentation du taux de césariennes en 2017 chez les femmes du groupe 1 (P = 0,0224) et des différences significatives quant à l'homogénéité de la distribution
des césariennes effectuées pour cause de souffrance fœtale entre les années dans ce
groupe (P = 0,0093). La vérification des cas de césariennes effectuées pour cause de souffrance
fœtale dans le groupe 1 en 2017 nous a permis de constater que l'indication était
appropriée dans tous les cas, mais aussi que dans 39,4 % des cas, la prise en charge
des contractions utérines pendant le travail était considérée comme sous-optimale.
Conclusion
La classification des césariennes à l'aide de la classification de Robson nous permet
de comparer les taux de césariennes au cours de différentes années et d'en analyser
les augmentations, le cas échéant. Les augmentations sont parfois attribuées à des
changements dans la population obstétricale, mais après une analyse approfondie, il
est possible de découvrir qu'elles sont plutôt liées à des problèmes pouvant être
corrigés. Il n'est pas nécessaire d'avoir un taux de césariennes élevé pour justifier
une vérification interne.
Keywords
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REFERENCES
- Appropriate technology for birth.Lancet. 1985; 2: 436-437
- Global epidemiology of use of and disparities in caesarean sections.Lancet. 2018; 392: 1341-1348
- The increasing trend in caesarean section rates: global, regional and national estimates: 1990–2014.PLoS One. 2016; 11e0148343
- Association between rising professional liability insurance premiums and primary cesarean delivery rates.Obstet Gynecol. 2007; 110: 1264-1269
- Obstetricians’ choice of cesarean delivery in ambiguous cases: is it influenced by risk attitude or fear of complaints and litigation?.Am J Obstet Gynecol. 2009; 200 (48.e1–8)
- WHO statement on caesarean section rates.BJOG. 2016; 123: 667-670
- Maternal and neonatal individual risk and benefits associated with caesarean delivery: multicentre prospective study.BMJ. 2007; 335: 1025
- Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004–2008 WHO Global Survey on Maternal and Perinatal Health.BMC Med. 2010; 8: 71
- Short-term and long-term effects of caesarean section on the health of women and children.Lancet. 2018; 392: 1349-1357
- Methods of achieving and maintaining an appropriate caesarean section rate.Best Pract Res Clin Obstet Gynaecol. 2013; 27: 297-308
- Systematic review of economic aspects of alternative modes of delivery.BJOG. 2001; 108: 149-157
- Inequities in the use of cesarean section deliveries in the world.Am J Obstet Gynecol. 2012; 206 (331.e1–19)
- WHO statement on caesarean section rates.World Health Organization, Geneva2015
- Classifications for cesarean section: a systematic review.PLoS One. 2011; 6: e14566
- FIGO position paper: how to stop the caesarean section epidemic.Lancet. 2018; 392: 1286-1287
- Interventions to reduce unnecessary caesarean sections in healthy women and babies.Lancet. 2018; 392: 1358-1368
- Classification of caesarean sections.Fetal Matern Med Rev. 2001; 12: 23-39
- Robson classification: implementation manual.World Health Organization, Geneva2017
- A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study.BJOG. 2016; 123: 427-436
Eustat. Basque Statistics Institute. Available at:http://en.eustat.eus/elementos/ele0005700/ti_Nacidos_vivos_y_tasa_de_natalidad_por_1000_habitantes_por_territorio_historico_1975-2018/tbl0005708_i.html. Accessed on August 20, 2020.
National Commission on Assisted Human Reproduction. Registro Nacional de actividad y resultados de los centros y servicios de Reproducción Humana Asistida. Available at:http://www.cnrha.mscbs.gob.es/registros/actividades.htm. Accessed on August 20, 2020.
- Maternal morbidity for vaginal and cesarean deliveries, according to previous cesarean history: new data from the birth certificate, 2013.Natl Vital Stat Rep. 2015; 64: 1-14
- Fetal presentation and successful twin vaginal delivery.Am J Obstet Gynecol. 2016; 214 (116.e1–10)
- Survival rates and mode of delivery for vertex preterm neonates according to small or appropriate for gestational age status.Pediatrics. 2006; 118: e1836-e1844
- The significance of base deficit in acidemic term neonates.Am J Obstet Gynecol. 2015; 213 (373.e1–7)
- Apgar score and the risk of cause-specific infant mortality: a population-based cohort study.Lancet. 2014; 384: 1749-1755
- Cesarean delivery rates using Robson classification system in Ireland: what can we learn?.Eur J Obstet Gynecol Reprod Biol. 2019; 236: 121-126
- Quality assurance: The 10-group classification system (Robson classification), induction of labor, and cesarean delivery.Int J Gynecol Obstet. 2015; 131: S23-S27
- Emergency cesarean delivery for nonreassuring fetal heart rate tracings.Compliance with ACOG guidelines. J Reprod Med. 2003; 48: 975-981
Article info
Publication history
Published online: August 07, 2020
Footnotes
Disclosures: The authors declare they have nothing to disclose.
All authors have indicated they meet the journal's requirements for authorship.
Identification
Copyright
© 2020 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
