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

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  • Aura Pyykönen
  • Mika Gissler
  • Ellen Løkkegaard
  • Thomas Bergholt
  • Steen C Rasmussen
  • Alexander Smárason
  • Ragnheiður I Bjarnadóttir
  • Birna Björg Másdóttir
  • Karin Källén
  • Kari Klungsoyr
  • Susanne Albrechtsen
  • Finn Egil Skjeldestad
  • Anna-Maija Tapper
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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 three-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 (16.4-20.7%), Norway (14.4-16.5%) and Sweden (15.5-17.1%), 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 (16.5-16.2%) mainly due to decrease among R5 and R6-R7 (breech presentation, nulliparous/multiparous). In Iceland, the cesarean rate decreased in all parturient groups (17.6-15.3%), 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. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalActa Obstetricia et Gynecologica Scandinavica
Volume96
Issue number5
Pages (from-to)607-616
ISSN0001-6349
DOIs
Publication statusPublished - 2017

ID: 49832836