Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys
Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys
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DOI：
10.1016/s2214-109x(15)70094-x
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发表时间：
2015-05-01
影响因子：
34.3
通讯作者：
Temmerman, Marleen
中科院分区：
文献类型：
--
作者：
Vogel, Joshua P.;Betran, Ana Pilar;Temmerman, Marleen
背景剖宫产率在全球范围内都在上升，但这种增长的决定因素，特别是在低收入和中等收入国家，是有争议的。在这项研究中，我们通过使用世界卫生组织对卫生保健机构分娩的两个多国调查中的Robson分类，旨在分析特定产科人口对剖腹产率变化的贡献。Robson系统根据五个参数将所有分娩分为十组之一：产科病史、分娩开始时间、胎儿位置、新生儿数量和孕龄。方法我们研究了21个国家287个机构的分娩情况，这些机构同时包括在世界卫生组织母婴健康全球调查(WHOGS；2004-08)和世卫组织母婴健康多国调查(WHOMCS；2010-11)中。我们使用这些调查的数据来确定每个国家的剖腹产率的年平均百分比变化(AAPC)。根据人类发展指数(HDI)组(非常高/高、中等或低)对国家进行分层，并对两个数据集应用罗布森标准。我们报告了每个罗布森组的相对大小，每个罗布森组的剖腹产率，以及每个罗布森组对整体剖腹产率的绝对和相对贡献。我们发现，在两次调查之间，剖腹产率总体上有所上升(从世界卫生组织的26.4%上升到世界卫生组织的31.2%，p=0.003)，在除日本以外的所有国家。产科干预措施(引产、产前剖宫产和整体剖腹产)的使用随着时间的推移而增加。在所有HDI类别中，大多数Robson组的剖腹产率都有所上升。在人类发展指数极高/高和低的国家，引产和产前剖腹产的使用率增加，在所有人类发展指数组中，经产妇引产后的剖腹产率显著增加。在中等和低人类发展指数国家，以前进行过剖腹产的妇女比例有所增加，这些妇女的剖腹产率也有所增加。罗布森标准的解释使用使不同国家和时间点的数据进行标准化比较，并确定推动剖腹产率变化的亚群。在人类发展指数中等或较低的国家，曾经进行过剖腹产的妇女是决定总体剖腹产率的一个日益重要的因素。减少手术频率的策略应该包括避免医学上不必要的初次剖腹产。改进引产和产前剖宫产的病例选择也可以降低剖宫产率。
Background Rates of caesarean section surgery are rising worldwide, but the determinants of this increase, especially in low-income and middle-income countries, are controversial. In this study, we aimed to analyse the contribution of specific obstetric populations to changes in caesarean section rates, by using the Robson classification in two WHO multicountry surveys of deliveries in health-care facilities. The Robson system classifies all deliveries into one of ten groups on the basis of five parameters: obstetric history, onset of labour, fetal lie, number of neonates, and gestational age.Methods We studied deliveries in 287 facilities in 21 countries that were included in both the WHO Global Survey of Maternal and Perinatal Health (WHOGS; 2004-08) and the WHO Multi-Country Survey of Maternal and Newborn Health (WHOMCS; 2010-11). We used the data from these surveys to establish the average annual percentage change (AAPC) in caesarean section rates per country. Countries were stratified according to Human Development Index (HDI) group (very high/high, medium, or low) and the Robson criteria were applied to both datasets. We report the relative size of each Robson group, the caesarean section rate in each Robson group, and the absolute and relative contributions made by each to the overall caesarean section rate.Findings The caesarean section rate increased overall between the two surveys (from 26.4% in the WHOGS to 31.2% in the WHOMCS, p=0.003) and in all countries except Japan. Use of obstetric interventions (induction, prelabour caesarean section, and overall caesarean section) increased over time. Caesarean section rates increased across most Robson groups in all HDI categories. Use of induction and prelabour caesarean section increased in very high/high and low HDI countries, and the caesarean section rate after induction in multiparous women increased significantly across all HDI groups. The proportion of women who had previously had a caesarean section increased in moderate and low HDI countries, as did the caesarean section rate in these women.Interpretation Use of the Robson criteria allows standardised comparisons of data across countries and timepoints and identifies the subpopulations driving changes in caesarean section rates. Women who have previously had a caesarean section are an increasingly important determinant of overall caesarean section rates in countries with a moderate or low HDI. Strategies to reduce the frequency of the procedure should include avoidance of medically unnecessary primary caesarean section. Improved case selection for induction and prelabour caesarean section could also reduce caesarean section rates.