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[Cesarean sections in the Centre-Val de Loire region: Practices and indications-the Robson Classification].

A-I Lecuyer1, S Baron1, C Diguisto2

  • 1Public Health and Epidemiology Unit (EpiDcliC), Teaching hospital of Tours, 37044 Tours, France; Research Team "Education, Ethics and Health" (EA7505), University of Tours, 37044 Tours, France.

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Cesarean section (c-section) rates in France's Centre-Val de Loire region show variations. A study found 32% of analyzed c-sections were potentially avoidable, highlighting areas for practice improvement.

Keywords:
Classification de RobsonCésarienne programméeIndicationPlanned cesarean sectionRegisterRegistreRobson classification

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Area of Science:

  • Obstetrics and Gynecology
  • Public Health
  • Reproductive Medicine

Background:

  • Cesarean section (c-section) practices and their variations across maternity units in the French Centre-Val de Loire region were investigated.
  • The study focused on the incidence of planned c-sections and potentially avoidable cesarean deliveries.

Purpose of the Study:

  • To analyze c-section rates and identify potentially avoidable procedures within the Centre-Val de Loire region.
  • To assess variations in planned c-section rates among different maternity care facilities.

Main Methods:

  • Utilized 2016 regional birth register data, classifying planned c-sections using the Robson classification (high/low risk).
  • Supplemented register data with a survey (September 2016 - February 2017) in 20 regional maternity units to detail c-section indications.

Main Results:

  • In 2016, 19.2% of births (nearly 26,000) in the region were by c-section, with 7.0% being planned.
  • Planned c-section rates varied by indication (breech, scarred uterus) and maternity level (higher rates in lower-level facilities).
  • Of 1,979 studied c-sections (18.6% of births), 246 (32%) were deemed potentially avoidable, primarily due to isolated indications like a single previous c-section or breech presentation.

Conclusions:

  • Recommended targeted use of radiologic pelvimetry and specific c-section protocols for scarred uterus or breech presentation, aligning with national guidelines.
  • Advocated for widespread adoption of the Robson classification to monitor and improve obstetric practices through inter-maternity comparisons.