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Abstract：
BACKGROUND: Cesarean delivery rates have increased globally resulting in a public health concern. We estimate rates of cesarean deliveries among Thai women using the World Health Organization (WHO) Robson Classification system and compare rates by Robson group to the Robson guideline for acceptable rates to identify groups that might benefit most from interventions for rate reduction.
METHODS: In 2017 and 2018, we established cohorts of pregnant women aged ≥ 18 years seeking prenatal care at two tertiary Thai hospitals and followed them until 6-8 weeks postpartum. Three in-person interviews (enrollment, end of pregnancy, and postpartum) were conducted using structured questionnaires to obtain demographic characteristics, health history, and delivery information. Cesarean delivery indication was classified based on core obstetric variables (parity, previous cesarean delivery, number of fetuses, fetal presentation, gestational week, and onset of labor) assigned to 10 groups according to the Robson Classification. Logistic regression was used to identify factors associated with cesarean delivery among nulliparous women with singleton, cephalic, term pregnancies.
RESULTS: Of 2,137 participants, 970 (45%) had cesarean deliveries. The median maternal age at delivery was 29 years (interquartile range, 25-35); 271 (13%) participants had existing medical conditions; and 446 (21%) had pregnancy complications. The cesarean delivery rate varied by Robson group. Multiparous women with > 1 previous uterine scar, with a single cephalic pregnancy, ≥ 37 weeks gestation (group 5) contributed the most (14%) to the overall cesarean rate, whereas those with a single pregnancy with a transverse or oblique lie, including women with previous uterine scars (group 9) contributed the least (< 1%). Factors independently associated with cesarean delivery included age ≥ 25 years, pre-pregnancy obesity, new/worsen medical condition during pregnancy, fetal distress, abnormal labor, infant size for gestational age ≥ 50th percentiles, and self-pay for delivery fees. Women with existing blood conditions were less likely to have cesarean delivery.
CONCLUSIONS: Almost one in two pregnancies among women in our cohorts resulted in cesarean deliveries. Compared to WHO guidelines, cesarean delivery rates were elevated in selected Robson groups indicating that tailored interventions to minimize non-clinically indicated cesarean delivery for specific groups of pregnancies may be warranted.
METHODS: In 2017 and 2018, we established cohorts of pregnant women aged ≥ 18 years seeking prenatal care at two tertiary Thai hospitals and followed them until 6-8 weeks postpartum. Three in-person interviews (enrollment, end of pregnancy, and postpartum) were conducted using structured questionnaires to obtain demographic characteristics, health history, and delivery information. Cesarean delivery indication was classified based on core obstetric variables (parity, previous cesarean delivery, number of fetuses, fetal presentation, gestational week, and onset of labor) assigned to 10 groups according to the Robson Classification. Logistic regression was used to identify factors associated with cesarean delivery among nulliparous women with singleton, cephalic, term pregnancies.
RESULTS: Of 2,137 participants, 970 (45%) had cesarean deliveries. The median maternal age at delivery was 29 years (interquartile range, 25-35); 271 (13%) participants had existing medical conditions; and 446 (21%) had pregnancy complications. The cesarean delivery rate varied by Robson group. Multiparous women with > 1 previous uterine scar, with a single cephalic pregnancy, ≥ 37 weeks gestation (group 5) contributed the most (14%) to the overall cesarean rate, whereas those with a single pregnancy with a transverse or oblique lie, including women with previous uterine scars (group 9) contributed the least (< 1%). Factors independently associated with cesarean delivery included age ≥ 25 years, pre-pregnancy obesity, new/worsen medical condition during pregnancy, fetal distress, abnormal labor, infant size for gestational age ≥ 50th percentiles, and self-pay for delivery fees. Women with existing blood conditions were less likely to have cesarean delivery.
CONCLUSIONS: Almost one in two pregnancies among women in our cohorts resulted in cesarean deliveries. Compared to WHO guidelines, cesarean delivery rates were elevated in selected Robson groups indicating that tailored interventions to minimize non-clinically indicated cesarean delivery for specific groups of pregnancies may be warranted.
摘要：
背景：剖腹产率在全球范围内增加，引起了公共卫生问题。我们使用世界卫生组织（WHO）Robson分类系统估计泰国妇女的剖宫产率，并将Robson组的剖宫产率与Robson指南中可接受的剖宫产率进行比较，以确定可能从降低剖宫产率的干预措施中受益最大的组。
方法：在2017年和2018年，我们建立了年龄≥18岁的孕妇队列，在两家泰国三级医院寻求产前护理，并随访至产后6-8周。三次面谈(登记，怀孕结束,和产后)使用结构化问卷进行，以获得人口学特征，健康史,和交付信息。剖宫产指征是根据核心产科变量(胎次，既往剖宫产,胎儿数量,胎儿表现,孕周,和分娩开始）根据Robson分类分配到10组。Logistic回归用于确定单胎未产妇剖宫产的相关因素。头颅，足月怀孕。
结果：在2,137名参与者中，970例（45%）剖宫产。分娩时的中位产妇年龄为29岁(四分位距，25-35）；271（13％）的参与者有现有的医疗条件；446（21％）有妊娠并发症。Robson组剖宫产率不同。先前子宫疤痕>1的经产妇女，单头妊娠，妊娠≥37周（第5组）对整体剖宫产率的贡献最大（14％），而那些一次怀孕有横向或倾斜谎言的人，包括先前有子宫疤痕的女性（第9组）的贡献最小（<1％）。与剖宫产分娩独立相关的因素包括年龄≥25岁，孕前肥胖,怀孕期间新的/恶化的医疗条件，胎儿窘迫,异常分娩,胎龄的婴儿大小≥50百分位数，并自付送货费。具有现有血液状况的妇女不太可能进行剖宫产。
结论：在我们的队列中，几乎每两个妊娠妇女中就有一个导致剖宫产。与世卫组织指南相比，在选定的Robson组中,剖宫产率升高,这表明可能需要针对特定妊娠组采取量身定制的干预措施,以尽量减少非临床指征剖宫产.
方法：在2017年和2018年，我们建立了年龄≥18岁的孕妇队列，在两家泰国三级医院寻求产前护理，并随访至产后6-8周。三次面谈(登记，怀孕结束,和产后)使用结构化问卷进行，以获得人口学特征，健康史,和交付信息。剖宫产指征是根据核心产科变量(胎次，既往剖宫产,胎儿数量,胎儿表现,孕周,和分娩开始）根据Robson分类分配到10组。Logistic回归用于确定单胎未产妇剖宫产的相关因素。头颅，足月怀孕。
结果：在2,137名参与者中，970例（45%）剖宫产。分娩时的中位产妇年龄为29岁(四分位距，25-35）；271（13％）的参与者有现有的医疗条件；446（21％）有妊娠并发症。Robson组剖宫产率不同。先前子宫疤痕>1的经产妇女，单头妊娠，妊娠≥37周（第5组）对整体剖宫产率的贡献最大（14％），而那些一次怀孕有横向或倾斜谎言的人，包括先前有子宫疤痕的女性（第9组）的贡献最小（<1％）。与剖宫产分娩独立相关的因素包括年龄≥25岁，孕前肥胖,怀孕期间新的/恶化的医疗条件，胎儿窘迫,异常分娩,胎龄的婴儿大小≥50百分位数，并自付送货费。具有现有血液状况的妇女不太可能进行剖宫产。
结论：在我们的队列中，几乎每两个妊娠妇女中就有一个导致剖宫产。与世卫组织指南相比，在选定的Robson组中,剖宫产率升高,这表明可能需要针对特定妊娠组采取量身定制的干预措施,以尽量减少非临床指征剖宫产.
