Analysis of cesarean section rate based on Robson Ten-Group Classification

doi:10.3877/cma.j.issn.1673-5250.2021.01.008

Objective

To investigate clinical application values on cesarean section rate in different groups of parturients based on Robson Ten-Group Classification method.

Methods

A total of 3 595 parturients with gestational age≥28 gestational weeks in Northern Jiangsu People′s Hospital from January 1 to December 31, 2019 were selected as research subjects. The 3 595 parturients were classified into 10 groups based on Robson Ten-Group Classification method: group 1 (n=685, primipara with gestational age ≥37 gestational weeks, single cephalic and spontaneous labour); group 2a (n=962, primipara with gestational age ≥37 gestational weeks, single cephalic and induced labour) or group 2b (n=258, primipara with gestational age ≥37 gestational weeks, single cephalic and cesarean section before labour); group 3 (n=325, multipara with gestational age ≥37 gestational weeks, single cephalic and spontaneous labour, excluding previous cesarean section); group 4 (n=237, multipara with gestational age ≥37 gestational weeks, single cephalic and induced labour or cesarean section before labour, excluding previous cesarean section); group 5 (n=575, multipara with gestational age ≥37 gestational weeks, single cephalic and previous cesarean section); group 6 (n=102, all nulliparous breeches); group 7 (n=52, all multiparous breeches, including previous cesarean section); group 8 (n=113, all multiple pregnancies, including previous cesarean section); group 9 (n=28, parturients with oblique or horizontal position pregnancy, including previous cesarean section); group 10 (n=258, parturients with gestational age<37 gestational weeks and single cephalic, including previous cesarean section). Retrospective analysis was used to collect clinical case data of all subjects, including cesarean section delivery history, cesarean section types, and indications for cesarean section and so on. The cesarean section rate of these 10 groups of parturients and distribution of cesarean section delivery indications were analyzed. The procedures followed in this study were in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013.

Results

①Among 3 595 parturients, the cesarean section rate was 41.75% (1 501/ 3 595), and 44.84% (673/1 501) of them were delivered by elective cesarean section. Among indications of cesarean section, scarred uterus accounted for 41.77% (627/1 501), malposition of fetus accounted for 10.26% (154/1 501), and abnormal labor process accounted for 9.26% (139/ 1 501), respectively. ②Analysis of 3 595 parturients using Robson Ten-Group Classification method showed that parturients in group 2 accounted for the largest proportion, 33.94% (1 220/3 595), and followed by parturients in group 1 and group 5, which were 19.05% (685/3 595) and 15.99% (575/ 3 595), respectively. The number of parturients with cesarean section in group 5, 2 and 10 ranked the top 3, accounting for 76.95% (1 155/1 501) of all parturients with cesarean section, and accounting for 32.13% (1 155/3 595) of all parturients. The cesarean section rates in group 5 to group 9 all were above 90%. ③The primary indication of cesarean section was abnormal labor process in group 1 and group 2a, accounting for 73.91% (17/23) and 67.44% (116/172), respectively. The primary indication of cesarean section in group 5 and group 10 was scar uterus, accounting for 98.59% (559/567) and 34.81% (55/158), respectively. In group 6, 7 and 9, the primary indication of cesarean section was malposition, accounting for 93.94% (93/99), 66.00% (33/50) and 100.00% (28/28), respectively. The primary indication of cesarean section in group 8 was multiple pregnancy, which accounted for 91.51% (97/106). Among the 86 parturients who received cesarean section without cesarean section indication, the proportion of parturients in group 2b was the highest, which was 90.70% (78/86).

Conclusions

Based on Robson Ten-Group Classification method, analysis of cesarean section rate and cesarean section delivery indications of different groups of parturients will help clinicians quickly identify the target population who needs to reduce cesarean section rate, and analyze the specific cesarean section delivery conditions of target population, so as to develop more effective and targeted interventions to control cesarean section rate.

Key words: Cesarean section, Robson ten-group classification, Cesarean section indications, Cesarean section rate, Parturient

表1 Robson十分类法产妇分类标准

产妇类别		产妇特征
1		孕龄≥37孕周、单胎头位、自然临产初产妇
2		孕龄≥37孕周、单胎头位初产妇
	2a		引产临产
	2b		临产前剖宫产
3		孕龄≥37孕周、单胎头位、自然临产经产妇(无剖宫产术分娩史)
4		孕龄≥37孕周、单胎头位经产妇(无剖宫产术分娩史)
	4a		引产临产
	4b		临产前剖宫产
5		孕龄≥37孕周、单胎头位、≥1次剖宫产术分娩史产妇
6		单胎臀位初产妇
7		单胎臀位经产妇(包括有剖宫产术分娩史者)
8		多胎妊娠产妇(包括有剖宫产术分娩史者)
9		斜位或横位单胎妊娠产妇(包括有剖宫产术分娩史者)
10		孕龄<37孕周、单胎头位产妇(包括有剖宫产术分娩史者)

表1 Robson十分类法产妇分类标准

产妇类别		产妇特征
1		孕龄≥37孕周、单胎头位、自然临产初产妇
2		孕龄≥37孕周、单胎头位初产妇
	2a		引产临产
	2b		临产前剖宫产
3		孕龄≥37孕周、单胎头位、自然临产经产妇(无剖宫产术分娩史)
4		孕龄≥37孕周、单胎头位经产妇(无剖宫产术分娩史)
	4a		引产临产
	4b		临产前剖宫产
5		孕龄≥37孕周、单胎头位、≥1次剖宫产术分娩史产妇
6		单胎臀位初产妇
7		单胎臀位经产妇(包括有剖宫产术分娩史者)
8		多胎妊娠产妇(包括有剖宫产术分娩史者)
9		斜位或横位单胎妊娠产妇(包括有剖宫产术分娩史者)
10		孕龄<37孕周、单胎头位产妇(包括有剖宫产术分娩史者)

表2 本研究3 595例产妇基本情况及产科相关特点[例数(%)]

临床项目		构成比或发生率	临床项目		构成比或发生率	临床项目			构成比或发生率
年龄(岁)			产妇类型			产妇来源
	<20	10(0.28)		初产妇	2 195(61.06)		本院接诊		3 535(98.33)
	20～34	3 220(89.57)		经产妇	1 400(38.94)		其他医院转诊		60(1.67)
	≥35	365(10.15)	剖宫产术分娩史次数(次)			分娩方式
分娩孕龄(周)				0	2 933(81.59)		经阴道分娩		2 094(58.25)
	28～31	47(1.31)		1	613(17.05)		剖宫产术分娩		1 501(41.75)
	32～36	468(13.02)		≥2	49(1.36)			择期	673(18.72)
	≥37	3 080(85.67)	分娩镇痛		571(15.88)			急诊	828(23.03)

表2 本研究3 595例产妇基本情况及产科相关特点[例数(%)]

临床项目		构成比或发生率	临床项目		构成比或发生率	临床项目			构成比或发生率
年龄(岁)			产妇类型			产妇来源
	<20	10(0.28)		初产妇	2 195(61.06)		本院接诊		3 535(98.33)
	20～34	3 220(89.57)		经产妇	1 400(38.94)		其他医院转诊		60(1.67)
	≥35	365(10.15)	剖宫产术分娩史次数(次)			分娩方式
分娩孕龄(周)				0	2 933(81.59)		经阴道分娩		2 094(58.25)
	28～31	47(1.31)		1	613(17.05)		剖宫产术分娩		1 501(41.75)
	32～36	468(13.02)		≥2	49(1.36)			择期	673(18.72)
	≥37	3 080(85.67)	分娩镇痛		571(15.88)			急诊	828(23.03)

表3 Robson十分类法的10类产妇剖宫产术分娩率、各类剖宫产术分娩的总体占比及构成比比较

产妇类别		所占比例[例数(%)]	各类剖宫产术分娩率[例数(%)]^a	各类剖宫产术分娩的总体占比(%)^b	剖宫产术分娩产妇构成比(%)^c
1		685(19.05)	23(3.36 )	0.64	1.53
2		1 220(33.94)	430(35.25)	11.96	28.65
	2a	962(26.76)	172(17.88)	4.78	11.46
	2b	258(7.18)	258(100.00)	7.18	17.19
3		325(9.04)	3(0.92)	0.08	0.20
4		237(6.59)	37(15.61)	1.03	2.47
	4a	211(5.87)	11(5.21)	0.31	0.73
	4b	26(0.72)	26(100.00)	0.72	1.73
5		575(15.99)	567(98.61)	15.77	37.77
6		102(2.84)	99(97.06)	2.75	6.60
7		52(1.45)	50(96.15)	1.39	3.33
8		113(3.14)	106(93.81)	2.95	7.06
9		28(0.78)	28(100.00)	0.78	1.87
10		258(7.18)	158(61.24)	4.39	10.53
合计		3 595(100.00)	1 501(41.75)	41.75	100.00

表3 Robson十分类法的10类产妇剖宫产术分娩率、各类剖宫产术分娩的总体占比及构成比比较

产妇类别		所占比例[例数(%)]	各类剖宫产术分娩率[例数(%)]^a	各类剖宫产术分娩的总体占比(%)^b	剖宫产术分娩产妇构成比(%)^c
1		685(19.05)	23(3.36 )	0.64	1.53
2		1 220(33.94)	430(35.25)	11.96	28.65
	2a	962(26.76)	172(17.88)	4.78	11.46
	2b	258(7.18)	258(100.00)	7.18	17.19
3		325(9.04)	3(0.92)	0.08	0.20
4		237(6.59)	37(15.61)	1.03	2.47
	4a	211(5.87)	11(5.21)	0.31	0.73
	4b	26(0.72)	26(100.00)	0.72	1.73
5		575(15.99)	567(98.61)	15.77	37.77
6		102(2.84)	99(97.06)	2.75	6.60
7		52(1.45)	50(96.15)	1.39	3.33
8		113(3.14)	106(93.81)	2.95	7.06
9		28(0.78)	28(100.00)	0.78	1.87
10		258(7.18)	158(61.24)	4.39	10.53
合计		3 595(100.00)	1 501(41.75)	41.75	100.00

表4 本研究1 501例剖宫产术分娩产妇的剖宫产术分娩指征分析[例数(%)]

剖宫产术分娩指征	发生率
无医学指征	86(5.73)
产程异常	139(9.26)
胎儿宫内窘迫	100(6.66)
妊娠期高血压疾病	54(3.60)
前置胎盘/胎盘早剥	51(3.40)
瘢痕子宫	627(41.77)
多胎妊娠	97(6.46)
胎位不正	154(10.26)
其他母体并发症	97(6.46)
其他胎儿并发症	96(6.40)

表4 本研究1 501例剖宫产术分娩产妇的剖宫产术分娩指征分析[例数(%)]

剖宫产术分娩指征	发生率
无医学指征	86(5.73)
产程异常	139(9.26)
胎儿宫内窘迫	100(6.66)
妊娠期高血压疾病	54(3.60)
前置胎盘/胎盘早剥	51(3.40)
瘢痕子宫	627(41.77)
多胎妊娠	97(6.46)
胎位不正	154(10.26)
其他母体并发症	97(6.46)
其他胎儿并发症	96(6.40)

表5 本研究1 501例剖宫产术分娩产妇剖宫产术分娩指征分布情况[例数(%)]

产妇类别	例数	无剖宫产术分娩指征	产程异常	胎儿宫内窘迫	妊娠期高血压疾病	前置胎盘/胎盘早剥	瘢痕子宫	多胎妊娠	胎位不正	其他母体并发症	其他胎儿并发症
1	23	0(0)	17(73.91)	3(13.04)	0(0)	2(8.70)	0(0)	0(0)	0(0)	1(4.35)	0(0)
2a	172	2(1.16)	116(67.44)	40(23.26)	3(1.74)	1(0.58)	0(0)	0(0)	0(0)	10(5.81)	0(0)
2b	258	78(30.23)	0(0)	28(10.85)	16(6.20)	12(4.65)	0(0)	0(0)	0(0)	42(16.28)	82(31.78)
3	3	2(66.67)	1(33.33)	0(0)	0(0)	0(0)	0(0)	0(0)	0(0)	0(0)	0(0)
4a	11	0(0)	5(45.45)	6(54.55)	0(0)	0(0)	0(0)	0(0)	0(0)	0(0)	0(0)
4b	26	4(15.38)	0(0)	4(15.38)	2(7.69)	5(19.23)	0(0)	0(0)	0(0)	5(19.23)	6(23.08)
5	567	0(0)	0(0)	0(0)	3(0.53)	3(0.53)	559(98.59)	0(0)	0(0)	2(0.35)	0(0)
6	99	0(0)	0(0)	0(0)	1(1.01)	1(1.01)	0(0)	0(0)	93(93.94)	3(3.03)	1(1.01)
7	50	0(0)	0(0)	0(0)	1(2.00)	3(6.00)	11(22.00)	0(0)	33(66.00)	1(2.00)	1(2.00)
8	106	0(0)	0(0)	0(0)	4(3.77)	2(1.89)	2(1.89)	97(91.51)	0(0)	1(0.94)	0(0)
9	28	0(0)	0(0)	0(0)	0(0)	0(0)	0(0)	0(0)	28(100.00)	0(0)	0(0)
10	158	0(0)	0(0)	19(12.03)	24(15.19)	22(13.92)	55(34.81)	0(0)	0(0)	32(20.25)	6(3.80)
合计	1 501	86(5.73)	139(9.26)	100(6.66)	54(3.60)	51(3.40)	627(41.77)	97(6.46)	154(10.26)	97(6.46)	96(6.40)

表5 本研究1 501例剖宫产术分娩产妇剖宫产术分娩指征分布情况[例数(%)]

产妇类别	例数	无剖宫产术分娩指征	产程异常	胎儿宫内窘迫	妊娠期高血压疾病	前置胎盘/胎盘早剥	瘢痕子宫	多胎妊娠	胎位不正	其他母体并发症	其他胎儿并发症
1	23	0(0)	17(73.91)	3(13.04)	0(0)	2(8.70)	0(0)	0(0)	0(0)	1(4.35)	0(0)
2a	172	2(1.16)	116(67.44)	40(23.26)	3(1.74)	1(0.58)	0(0)	0(0)	0(0)	10(5.81)	0(0)
2b	258	78(30.23)	0(0)	28(10.85)	16(6.20)	12(4.65)	0(0)	0(0)	0(0)	42(16.28)	82(31.78)
3	3	2(66.67)	1(33.33)	0(0)	0(0)	0(0)	0(0)	0(0)	0(0)	0(0)	0(0)
4a	11	0(0)	5(45.45)	6(54.55)	0(0)	0(0)	0(0)	0(0)	0(0)	0(0)	0(0)
4b	26	4(15.38)	0(0)	4(15.38)	2(7.69)	5(19.23)	0(0)	0(0)	0(0)	5(19.23)	6(23.08)
5	567	0(0)	0(0)	0(0)	3(0.53)	3(0.53)	559(98.59)	0(0)	0(0)	2(0.35)	0(0)
6	99	0(0)	0(0)	0(0)	1(1.01)	1(1.01)	0(0)	0(0)	93(93.94)	3(3.03)	1(1.01)
7	50	0(0)	0(0)	0(0)	1(2.00)	3(6.00)	11(22.00)	0(0)	33(66.00)	1(2.00)	1(2.00)
8	106	0(0)	0(0)	0(0)	4(3.77)	2(1.89)	2(1.89)	97(91.51)	0(0)	1(0.94)	0(0)
9	28	0(0)	0(0)	0(0)	0(0)	0(0)	0(0)	0(0)	28(100.00)	0(0)	0(0)
10	158	0(0)	0(0)	19(12.03)	24(15.19)	22(13.92)	55(34.81)	0(0)	0(0)	32(20.25)	6(3.80)
合计	1 501	86(5.73)	139(9.26)	100(6.66)	54(3.60)	51(3.40)	627(41.77)	97(6.46)	154(10.26)	97(6.46)	96(6.40)

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