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

• Published in: Acta Obstetricia et Gynecologica Scandinavica
• Main Authors: Pyykönen, Aura, Gissler, Mika, Løkkegaard, Ellen, Bergholt, Thomas, Rasmussen, Steen C, Smárason, Alexander, Bjarnadóttir, Ragnheiður I, Másdóttir, Birna B, Källén, Karin, Klungsoyr, Kari, Albrechtsen, Susanne, Skjeldestad, Finn E, Tapper, Anna-Maija
• Other Authors: 1 Univ Helsinki, Helsinki, Finland Show the Organization-Enhanced name(s) 2 Helsinki Univ Hosp, Dept Obstet & Gynecol, Helsinki, Finland Show the Organization-Enhanced name(s) 3 Natl Inst Hlth & Welf THL, Helsinki, Finland Show the Organization-Enhanced name(s) 4 Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med, Stockholm, Sweden Show the Organization-Enhanced name(s) 5 Univ Copenhagen, Copenhagen, Denmark 6 Nordsjaelland Hosp, Dept Obstet & Gynecol, Hillerod, Denmark Show the Organization-Enhanced name(s) 7 Rigshosp, Dept Obstet, Copenhagen, Denmark 8 Iceland Birth Registry, Akureyri, Iceland 9 Univ Akureyri, Inst Hlth Sci Res, Akureyri, Iceland 10 Landspitali Univ Hosp, Reykajvik, Iceland 11 Swedish Natl Board Hlth & Welf, Stockholm, Sweden Show the Organization-Enhanced name(s) 12 Lund Univ, Lund, Sweden 13 Norwegian Inst Publ Hlth, Dept Hlth Registries, Bergen, Norway Show the Organization-Enhanced name(s) 14 Univ Bergen, Dept Clin Sci, Bergen, Norway 15 Haukeland Hosp, Bergen, Norway Show the Organization-Enhanced name(s) 16 UiT Arctic Univ Norway, Dept Community Med, Fac Hlth Sci, Tromso, Norway 17 Hyvinkaa Hosp, Hyvinkaa, Finland
• Format: Article in Journal/Newspaper
• Language: English
• Published: Wiley 2017
• Subjects: Keisaraskurðir; Norðurlandabúar; Norðurlönd; OAG; Cesarean Section; Scandinavian and Nordic Countries; Norway; Iceland
• Online Access: http://hdl.handle.net/2336/620224; https://doi.org/10.1111/aogs.13108

To access publisher's full text version of this article click on the hyperlink below 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. 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. 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. 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.