Which is the target population for stabilising the caesarean rate?

Proposing and evaluating interventions for improving the management of labour in nulliparas could help to maintain caesarean rates and mitigate increases among multiparas in the future

Abstract

Objective

The caesarean rate increased in France between 1995 and 2003, but remained stable between 2003 and 2010. Our objective was to analyze these trends by identifying the groups of women who contributed to the increase and those who contributed to the stabilization.

Methods

the French national perinatal surveys provide representative samples of women delivering in 1995 (N=13147), 2003 (N=14482), and 2010 (N=14681). Using the Robson 12-group classification based on pregnancy and delivery characteristics, we calculated, for each group, the caesarean rate, its contribution to the overall caesarean rate, and the differences (Δ) in these contributions, between 1995 and 2003 and between 2003 and 2010.

Results

Overall caesarean rates were 15.4% in 1995, 19.7% in 2003, and 20.5% in 2010. Between 1995 and 2003, the contribution to the overall caesarean rate of all groups but one rose. Between 2003 and 2010, the contribution of all groups but three stabilized or decreased: nulliparas in spontaneous labour with singleton cephalic foetuses at term(Δ=+0.5%, 95%CI 0.1;0.9), an increase explained by their higher caesarean rate; nulliparas with induced labour at term (Δ=+1.1% 95% CI 0.8;1.4) caused by an increase in both the caesarean rate and the relative size of this group; and women with previous caesarean (Δ=+0.8%, 95%CI 0.3;1.3), because of the growing size of this group.

Conclusion

Proposing and evaluating interventions for improving the management of labour in nulliparas could help to maintain caesarean rates and mitigate increases among multiparas in the future.

To learn more

Le Ray C, Blondel B, Prunet C, Khireddine I, Deneux-Tharaux C, Goffinet F. Stabilising the caesarean rate: which target population? BJOG. 2015 Apr;122(5):690-9.

Le Ray C, Prunet C, Deneux-Tharaux C, Goffinet F, Blondel B. Classification de Robson : un outil d’évaluation des pratiques de césarienne en France. J Gynecol Obstet Biol Reprod (Paris). 2015 Apr 7. pii: S0368-2315(15)00062-9.