Analysis  of caesarean section rates over time in a single Swiss centre using a ten-group  classification system

Martin Müller; Laura Kolly; Marc Bauman; Sara Imboden; Daniel Surbek

doi:10.4414/smw.2014.13921

Original article

Vol. 144 No. 0708 (2014)

Analysis of caesarean section rates over time in a single Swiss centre using a ten-group classification system

Martin Müller
Laura Kolly
Marc Bauman
Sara Imboden
Daniel Surbek

DOI: https://doi.org/10.4414/smw.2014.13921
Cite this as:: Swiss Med Wkly. 2014;144:w13921
Published: 09.02.2014

Summary

OBJECTIVE: Caesarean section (CS) rates have risen over the past two decades. The aim of this observational study was to identify time-dependent variations in CS and vaginal delivery rates over a period of 11 years.

METHOD: All deliveries (13,701 deliveries during the period 1999–2009) at the University Women’s Hospital Bern were analysed using an internationally standardised and approved ten-group classification system. Caesarean sections on maternal request (CSMR) were evaluated separately.

RESULTS: We detected an overall CS rate of 36.6% and an increase in the CS rate over time (p <0.001). Low-risk profile groups were the two largest populations and displayed low CS rates, with significantly decreasing relative size over time. The relative size of groups with induced labour increased significantly, but this did not have an impact on the overall CS rate. Pregnancies complicated by breech position, multiple pregnancies and abnormal lies did not have an impact on overall CS rate. The biggest contributor to a high CS rate was preterm delivery and the existence of a uterine scar from a previous CS. CSMR was 1.45% and did not have an impact on the overall CS rate.

CONCLUSION: The observational study identified wide variations in caesarean section and vaginal delivery rates across the groups over time, and a shift towards high-risk populations was noted. The biggest contributors to high CS rates were identified; namely, previous uterine scar and preterm delivery. Interventions aiming to reduce CS rates are planned.

References

Althabe F, Sosa C, Belizan JM, Gibbons L, Jacquerioz F, Bergel E. Cesarean section rates and maternal and neonatal mortality in low-, medium-, and high-income countries: an ecological study. Birth. 2006;33(4):270–7.
Habiba M, Kaminski M, Da Fre M, Marsal K, Bleker O, Librero J, et al. Caesarean section on request: a comparison of obstetricians’ attitudes in eight European countries. BJOG: an international journal of obstetrics and gynaecology 2006;113(6):647–56.
Joseph KS, Young DC, Dodds L, O’Connell CM, Allen VM, Chandra S, et al. Changes in maternal characteristics and obstetric practice and recent increases in primary cesarean delivery. Obstet Gynecol. 2003;102(4):791–800.
Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004;351(25):2581–9.
Appropriate technology for birth. Lancet. 1985;2(8452):436–7.
Torloni MR, Betran AP, Souza JP, Widmer M, Allen T, Gulmezoglu M, et al. Classifications for cesarean section: a systematic review. PloS one. 2011;6(1):e14566.
Robson MS. Can we reduce the caesarean section rate? Best practice & research Clin Obstetr Gynaecol. 2001;15(1):179–94.
Brennan DJ, Robson MS, Murphy M, O’Herlihy C. Comparative analysis of international cesarean delivery rates using 10–group classification identifies significant variation in spontaneous labor. Am J Obstet Gynecol. 2009;201(3):308 e301–308.
Florica M, Stephansson O, Nordstrom L. Indications associated with increased cesarean section rates in a Swedish hospital. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2006;92(2):181–5.
Delbaere I, Cammu H, Martens E, Tency I, Martens G, Temmerman M: Limiting the caesarean section rate in low risk pregnancies is key to lowering the trend of increased abdominal deliveries: an observational study. BMC Pregnancy Childbirth. 2012;12:3.
Wei S, Wo BL, Qi HP, Xu H, Luo ZC, Roy C, et al. Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care. Cochrane Database Syst Rev 2012;9: CD006794.
Ehrenthal DB, Jiang X, Strobino DM. Labor induction and the risk of a cesarean delivery among nulliparous women at term. Obstet Gynecol. 2010;116(1):35–42.
Nicholson JM, Parry S, Caughey AB, Rosen S, Keen A, Macones GA. The impact of the active management of risk in pregnancy at term on birth outcomes: a randomized clinical trial. Am J Obstetr Gynecol. 2008;198(5):511 e511–515.
Grobman WA. Elective induction: When? Ever? Clin Obstet Gynecol. 2007;50(2):537–46.
Zhang J, Troendle J, Reddy UM, Laughon SK, Branch DW, Burkman R, et al. Contemporary cesarean delivery practice in the United States. Am J Obstetr Gynecol. 2010;203(4):326 e321–326 e310.
Landon MB: Vaginal birth after cesarean delivery. Clin Perinatol. 2008;35(3):491–504, ix-x.
Macones GA. Clinical outcomes in VBAC attempts: what to say to patients? Am J Obstetr Gynecol. 2008;199(1):1–2.
Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet. 2000;356(9239):1375–83.
Hofmeyr GJ, Barrett JF, Crowther CA. Planned caesarean section for women with a twin pregnancy. Cochrane Database Syst Rev 2011(12):CD006553.
Scarella A, Chamy V, Sepulveda M, Belizan JM. Medical audit using the Ten Group Classification System and its impact on the cesarean section rate. Eur J Obstetr Gynecol Reprod Biol. 2011;154(2):136–40.
Karlstrom A, Lindgren H, Hildingsson I. Maternal and infant outcome after caesarean section without recorded medical indication: findings from a Swedish case-control study. BJOG: an international journal of obstetrics and gynaecology 2013;120(4):479–86; discussion 486.
Stjernholm YV, Petersson K, Eneroth E. Changed indications for cesarean sections. Acta Obstet Gynecol Scand. 2010;89(1):49–53.
Soderquist J, Wijma B, Thorbert G, Wijma K. Risk factors in pregnancy for post-traumatic stress and depression after childbirth. BJOG: an international journal of obstetrics and gynaecology 2009;116(5):672–80.
Wiklund I, Andolf E, Lilja H, Hildingsson I. Indications for cesarean section on maternal request – guidelines for counseling and treatment. Sexual & reproductive healthcare: official journal of the Swedish Association of Midwives 2012;3(3):99–106.
Lynch CM, Sexton DJ, Hession M, Morrison JJ. Obesity and mode of delivery in primigravid and multigravid women. Am J Perinatol. 2008;25(3):163–7.

How to Cite

1.

Müller M, Kolly L, Bauman M, Imboden S, Surbek D. Analysis of caesarean section rates over time in a single Swiss centre using a ten-group classification system. Swiss Med Wkly [Internet]. 2014 Feb. 9 [cited 2024 Apr. 24];144(0708):w13921. Available from: https://smw.ch/index.php/smw/article/view/1821

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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[1] Althabe F, Sosa C, Belizan JM, Gibbons L, Jacquerioz F, Bergel E. Cesarean section rates and maternal and neonatal mortality in low-, medium-, and high-income countries: an ecological study. Birth. 2006;33(4):270–7.

[2] Habiba M, Kaminski M, Da Fre M, Marsal K, Bleker O, Librero J, et al. Caesarean section on request: a comparison of obstetricians’ attitudes in eight European countries. BJOG: an international journal of obstetrics and gynaecology 2006;113(6):647–56.

[3] Joseph KS, Young DC, Dodds L, O’Connell CM, Allen VM, Chandra S, et al. Changes in maternal characteristics and obstetric practice and recent increases in primary cesarean delivery. Obstet Gynecol. 2003;102(4):791–800.

[4] Landon MB, Hauth JC, Leveno KJ, Spong CY, Leindecker S, Varner MW, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004;351(25):2581–9.

[5] Appropriate technology for birth. Lancet. 1985;2(8452):436–7.

[6] Torloni MR, Betran AP, Souza JP, Widmer M, Allen T, Gulmezoglu M, et al. Classifications for cesarean section: a systematic review. PloS one. 2011;6(1):e14566.

[7] Robson MS. Can we reduce the caesarean section rate? Best practice & research Clin Obstetr Gynaecol. 2001;15(1):179–94.

[8] Brennan DJ, Robson MS, Murphy M, O’Herlihy C. Comparative analysis of international cesarean delivery rates using 10–group classification identifies significant variation in spontaneous labor. Am J Obstet Gynecol. 2009;201(3):308 e301–308.

[9] Florica M, Stephansson O, Nordstrom L. Indications associated with increased cesarean section rates in a Swedish hospital. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2006;92(2):181–5.

[10] Delbaere I, Cammu H, Martens E, Tency I, Martens G, Temmerman M: Limiting the caesarean section rate in low risk pregnancies is key to lowering the trend of increased abdominal deliveries: an observational study. BMC Pregnancy Childbirth. 2012;12:3.

[11] Wei S, Wo BL, Qi HP, Xu H, Luo ZC, Roy C, et al. Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care. Cochrane Database Syst Rev 2012;9: CD006794.

[12] Ehrenthal DB, Jiang X, Strobino DM. Labor induction and the risk of a cesarean delivery among nulliparous women at term. Obstet Gynecol. 2010;116(1):35–42.

[13] Nicholson JM, Parry S, Caughey AB, Rosen S, Keen A, Macones GA. The impact of the active management of risk in pregnancy at term on birth outcomes: a randomized clinical trial. Am J Obstetr Gynecol. 2008;198(5):511 e511–515.

[14] Grobman WA. Elective induction: When? Ever? Clin Obstet Gynecol. 2007;50(2):537–46.

[15] Zhang J, Troendle J, Reddy UM, Laughon SK, Branch DW, Burkman R, et al. Contemporary cesarean delivery practice in the United States. Am J Obstetr Gynecol. 2010;203(4):326 e321–326 e310.

[16] Landon MB: Vaginal birth after cesarean delivery. Clin Perinatol. 2008;35(3):491–504, ix-x.

[17] Macones GA. Clinical outcomes in VBAC attempts: what to say to patients? Am J Obstetr Gynecol. 2008;199(1):1–2.

[18] Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet. 2000;356(9239):1375–83.

[19] Hofmeyr GJ, Barrett JF, Crowther CA. Planned caesarean section for women with a twin pregnancy. Cochrane Database Syst Rev 2011(12):CD006553.

[20] Scarella A, Chamy V, Sepulveda M, Belizan JM. Medical audit using the Ten Group Classification System and its impact on the cesarean section rate. Eur J Obstetr Gynecol Reprod Biol. 2011;154(2):136–40.

[21] Karlstrom A, Lindgren H, Hildingsson I. Maternal and infant outcome after caesarean section without recorded medical indication: findings from a Swedish case-control study. BJOG: an international journal of obstetrics and gynaecology 2013;120(4):479–86; discussion 486.

[22] Stjernholm YV, Petersson K, Eneroth E. Changed indications for cesarean sections. Acta Obstet Gynecol Scand. 2010;89(1):49–53.

[23] Soderquist J, Wijma B, Thorbert G, Wijma K. Risk factors in pregnancy for post-traumatic stress and depression after childbirth. BJOG: an international journal of obstetrics and gynaecology 2009;116(5):672–80.

[24] Wiklund I, Andolf E, Lilja H, Hildingsson I. Indications for cesarean section on maternal request – guidelines for counseling and treatment. Sexual & reproductive healthcare: official journal of the Swedish Association of Midwives 2012;3(3):99–106.

[25] Lynch CM, Sexton DJ, Hession M, Morrison JJ. Obesity and mode of delivery in primigravid and multigravid women. Am J Perinatol. 2008;25(3):163–7.