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

Authors: Aura Pyykönen; Mika Gissler; Ellen Løkkegaard; Thomas Bergholt; Steen C. Rasmussen; Alexander Smárason; Ragnheiður I. Bjarnadóttir; +6 Authors

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

Abstract

AbstractIntroductionThe 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 methodsRetrospective 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.ResultsBetween 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.ConclusionsThe 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.

Country
Denmark
Keywords

induction of labor, Databases, Factual, uterine scar, Cesarean Section, Infant, Newborn, Pregnancy Outcome, Scandinavian and Nordic Countries, Robson classification, Pregnancy, Humans, Female, Maternal Health Services, delivery, Cesarean section, Retrospective Studies

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    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
91
Top 1%
Top 10%
Top 1%
gold