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

Aura Pyykönen; Mika Gissler; Ellen Løkkegaard; Thomas Bergholt; Steen C. Rasmussen; Alexander Smárason; Ragnheiður I. Bjarnadóttir; Birna B. Másdóttir; Karin Källén; Kari Klungsoyr; Susanne Albrechtsen; Finn E. Skjeldestad; Anna Maija Tapper

doi:10.1111/aogs.13108

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

Aura Pyykönen^*, Mika Gissler, Ellen Løkkegaard, Thomas Bergholt, Steen C. Rasmussen, Alexander Smárason, Ragnheiður I. Bjarnadóttir, Birna B. Másdóttir, Karin Källén, Kari Klungsoyr, Susanne Albrechtsen, Finn E. Skjeldestad, Anna Maija Tapper

^*Corresponding author for this work

Department of Clinical Medicine

41 Citations (Scopus)

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.

Original language	English
Journal	Acta Obstetricia et Gynecologica Scandinavica
Volume	96
Issue number	5
Pages (from-to)	607-616
Number of pages	10
ISSN	0001-6349
DOIs	https://doi.org/10.1111/aogs.13108
Publication status	Published - 1 May 2017

Keywords

Cesarean section
delivery
induction of labor
Robson classification
uterine scar

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Pyykönen, A., Gissler, M., Løkkegaard, E., Bergholt, T., Rasmussen, S. C., Smárason, A., Bjarnadóttir, R. I., Másdóttir, B. B., Källén, K., Klungsoyr, K., Albrechtsen, S., Skjeldestad, F. E., & Tapper, A. M. (2017). Cesarean section trends in the Nordic Countries – a comparative analysis with the Robson classification. Acta Obstetricia et Gynecologica Scandinavica, 96(5), 607-616. https://doi.org/10.1111/aogs.13108

Pyykönen, A, Gissler, M, Løkkegaard, E , Bergholt, T, Rasmussen, SC, Smárason, A, Bjarnadóttir, RI, Másdóttir, BB, Källén, K, Klungsoyr, K, Albrechtsen, S, Skjeldestad, FE & Tapper, AM 2017, 'Cesarean section trends in the Nordic Countries – a comparative analysis with the Robson classification', Acta Obstetricia et Gynecologica Scandinavica, vol. 96, no. 5, pp. 607-616. https://doi.org/10.1111/aogs.13108

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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.",

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T1 - Cesarean section trends in the Nordic Countries – a comparative analysis with the Robson classification

AU - Pyykönen, Aura

AU - Gissler, Mika

AU - Løkkegaard, Ellen

AU - Bergholt, Thomas

AU - Rasmussen, Steen C.

AU - Smárason, Alexander

AU - Bjarnadóttir, Ragnheiður I.

AU - Másdóttir, Birna B.

AU - Källén, Karin

AU - Klungsoyr, Kari

AU - Albrechtsen, Susanne

AU - Skjeldestad, Finn E.

AU - Tapper, Anna Maija

PY - 2017/5/1

Y1 - 2017/5/1

N2 - 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.

AB - 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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KW - delivery

KW - induction of labor

KW - Robson classification

KW - uterine scar

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

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