Study On The Trend Of Caesarean Section Rate And Relevant Factors Based On Robson Classification Of Pregnancy

Objectives:Based on Robson ten group classification system(TGCS)and combined with cesarean section(CS)indications,this study retrospectively analyzed the changes in CS rate in the hospital from 2015 to 2019 and further analyzed the related factors affecting the CS rate to provide evidence-based medicine basis for reducing the CS rate.Methods:A total of 17,851 parturients with gestational age≥28 weeks,live fetus,and induced labor without fetal malformation delivered from January 1,2015,to December 31,2019,in the hospital were selected as the research subjects.The retrospective analysis method was used in this study,collecting relevant clinical case data of all subjects,including gestational age of delivery,number of deliveries,mode of delivery,fetal position,number of fetuses,and induction of labor,indications for CS,etc.All the subjects were grouped by TGCS(group 1-10),and the indications of CS were classified.The CS rate and the distribution of CS indications were analyzed statistically.Finally,all data were statistically analyzed using SAS 9.4 software,and the test standard was P<0.05,indicating that the difference is statistically significant.Results:1、During 2015-2019,the hospital’s total CS rate decreased from 53.4%to 41.9%,but the overall decreasing trend was not statistically significant(P=0.053).The primiparas’ CS rate decreased significantly in 5 years,and the difference was statistically significant(P<0.05).2、During 2015-2019,the utilization rate of vaginal midwifery in our hospital(the number of women with vaginal midwifery/the total number of women with vaginal delivery)was only 0.1%.3、The composition ratio of group 1(≥37 gestational weeks,single pregnancy,head presentation,primiparity,spontaneous labor)and group 2b(≥37 gestational weeks,single pregnancy,head presentation,primiparity,CS before delivery)showed a decreasing trend,and the differences were statistically significant(P<0.05),the composition ratio of group 2a(≥37 gestational weeks,single pregnancy,head presentation,primiparity,induced labor)showed an upward trend.The difference was statistically significant(P<0.05).There was no significant difference in the composition of the other groups.4、The CS rate in group 2b showed a significant downward trend,and the difference was statistically significant.The change of total CS rate was most correlated with the change of CS rate in group 2b(r=0.995,P<0.05).5、The proportion of cesarean section delivery in group 5(≥37 gestational weeks,single pregnancy,head presentation,previous CS)was between 26.4%and 39.7%,which contributed the most to the cesarean section rate.The composition ratio of group 6(single breech primipara),7(single breech postpartum),8(multiple pregnancies),and 9(single fetus oblique or transverse)was relatively stable,which had little effect on the total CS rate.The proportion of women who delivered by cesarean section in group 10(single pregnancy,head presentation,preterm birth)was 10.6%(877/8264),and the primary indication of cesarean section in group 10 was the history of cesarean section delivery.6、Failure of induction of labor and history of CS as the indications of CS showed a significant upward trend in the composition ratio,and the difference was statistically significant(P<0.05);The ratio of oligohydramnios,macrosomia,and umbilical cord factors decreased obviously,and the difference was statistically significant(P<0.05).Conclusions:1、The variation trend of CS rate and the indications of CS were different among different population characteristics.2、Group 1,2,5,and 10 were the key monitoring objects to reduce the CS rate.Vaginal midwifery and vaginal delivery after CS are the focus and difficulty of obstetric technology development.3、The combined application of TGCS and the classification of CS indications is of great value in the future study of CS rates in different regions and hospitals.