Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys

Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys

Author Vogel, Joshua P. Google Scholar
Betran, Ana Pilar Google Scholar
Vindevoghel, Nadia Google Scholar
Souza, Joao Paulo Google Scholar
Torloni, Maria Regina Autor UNIFESP Google Scholar
Zhang, Jun Google Scholar
Tuncalp, Oezge Google Scholar
Mori, Rintaro Google Scholar
Morisaki, Naho Google Scholar
Ortiz-Panozo, Eduardo Google Scholar
Hernandez, Bernardo Google Scholar
Perez-Cuevas, Ricardo Google Scholar
Qureshi, Zahida Google Scholar
Guelmezoglu, A. Metin Google Scholar
Temmerman, Marleen Google Scholar
WHO Multi-Country Survey Maternal Google Scholar
Institution Univ Western Australia
World Hlth Org
Alberta Hlth
Universidade de São Paulo (USP)
GLIDE Tech Cooperat & Res
Universidade Federal de São Paulo (UNIFESP)
Brazilian Cochrane Ctr
Shanghai Jiao Tong Univ
Natl Ctr Child Hlth & Dev
Univ Tokyo
Natl Inst Publ Hlth
Univ Washington
Interamer Dev Bank
Univ Nairobi
Abstract Background Rates of caesarean section surgery are rising worldwide, but the determinants of this increase, especially in low-income and middle-income countries, are controversial. in this study, we aimed to analyse the contribution of specific obstetric populations to changes in caesarean section rates, by using the Robson classification in two WHO multicountry surveys of deliveries in health-care facilities. the Robson system classifies all deliveries into one of ten groups on the basis of five parameters: obstetric history, onset of labour, fetal lie, number of neonates, and gestational age.Methods We studied deliveries in 287 facilities in 21 countries that were included in both the WHO Global Survey of Maternal and Perinatal Health (WHOGS; 2004-08) and the WHO Multi-Country Survey of Maternal and Newborn Health (WHOMCS; 2010-11). We used the data from these surveys to establish the average annual percentage change (AAPC) in caesarean section rates per country. Countries were stratified according to Human Development Index (HDI) group (very high/high, medium, or low) and the Robson criteria were applied to both datasets. We report the relative size of each Robson group, the caesarean section rate in each Robson group, and the absolute and relative contributions made by each to the overall caesarean section rate.Findings the caesarean section rate increased overall between the two surveys (from 26.4% in the WHOGS to 31.2% in the WHOMCS, p=0.003) and in all countries except Japan. Use of obstetric interventions (induction, prelabour caesarean section, and overall caesarean section) increased over time. Caesarean section rates increased across most Robson groups in all HDI categories. Use of induction and prelabour caesarean section increased in very high/high and low HDI countries, and the caesarean section rate after induction in multiparous women increased significantly across all HDI groups. the proportion of women who had previously had a caesarean section increased in moderate and low HDI countries, as did the caesarean section rate in these women.Interpretation Use of the Robson criteria allows standardised comparisons of data across countries and timepoints and identifies the subpopulations driving changes in caesarean section rates. Women who have previously had a caesarean section are an increasingly important determinant of overall caesarean section rates in countries with a moderate or low HDI. Strategies to reduce the frequency of the procedure should include avoidance of medically unnecessary primary caesarean section. Improved case selection for induction and prelabour caesarean section could also reduce caesarean section rates.
Language English
Sponsor Australian Postgraduate Award
A & A Saw Scholarship
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction
Government of China
Government of India
Government of Japan
United States Agency for International Development (USAID)
Ministry of Health, Labour and Welfare of Japan
Gynuity Health Projects
Date 2015-05-01
Published in Lancet Global Health. Oxford: Elsevier B.V., v. 3, n. 5, p. E260-E270, 2015.
ISSN 2214-109X (Sherpa/Romeo, impact factor)
Publisher Elsevier B.V.
Extent E260-E270
Access rights Closed access
Type Article
Web of Science ID WOS:000353150900012

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