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

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Epidemiology

Background:

• Cesarean delivery rates are increasing across Nordic countries.
• Understanding the drivers of these changes is crucial for public health initiatives.

Purpose of the Study:

• To analyze changes in cesarean rates using the Robson classification.
• To identify specific obstetric groups contributing to cesarean rate trends in Nordic countries.

Main Methods:

• Retrospective population-based registry study.
• Inclusion of over 3.3 million deliveries across Denmark, Finland, Iceland, Norway, and Sweden (2000-2011).
• Analysis of Robson group distribution, cesarean rates, and contributions to changes over time.

Main Results:

• Cesarean rates increased in Denmark, Norway, and Sweden, primarily due to rises in women with previous cesareans (R5) and induced nulliparous labors (R2a).
• Finland and Iceland observed slight decreases or stabilization in cesarean rates, with specific reductions in R5 and breech presentations (R6-R7).
• Increased induction rates in nulliparous women did not clearly impact overall cesarean rates.

Conclusions:

• Rising cesarean rates are linked to increased rates among nulliparous women and those with prior cesarean deliveries.
• The Robson classification is a valuable tool for benchmarking and targeting interventions to lower cesarean rates.
• Further research is needed to clarify the impact of induction on cesarean rates in nulliparous women.