Non-Clinical Variables Influencing Cesarean Section Rate According to Robson Classification
1
Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, 50134 Florence, Italy
2
Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, 50134 Florence, Italy
3
Department of Obstetrics and Gynecology, New York Health and Hospitals/Lincoln, Bronx, NY 10451, USA
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Medicina 2020, 56(4), 180; https://doi.org/10.3390/medicina56040180
Received: 6 March 2020
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Revised: 3 April 2020
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Accepted: 13 April 2020
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Published: 15 April 2020
(This article belongs to the Special Issue Pregnancy: Diagnosis, Misdiagnosis, Complications and Outcomes)
Background and Objectives: The incidence of cesarean section (CS) has progressively increased worldwide, without any proven benefit to either the mother or the newborn. The aim of this study was to evaluate the association between CS rates and both clinical and non-clinical variables, while applying the Robson classification system. Materials and Methods: This is a retrospective observational study of pregnant women delivering at a tertiary care hospital between 2012 and 2017, either under public or private healthcare. The overall CS rate, and the elective and non-elective CS rate, divided by classes of Robson, were determined. The rate of vaginal deliveries and CSs was compared between the public and private setting. The distribution of incidence of non-elective CSs and their main indications were analyzed between daytime and nighttime. Results: 18,079 patients delivered during the study period: 69.2% delivered vaginally and 30.8% by CS. Robson class 5 was the most frequent (23.4%), followed by class 2B (16.8%). Of the 289 private practice deliveries, 59.2% were CSs. The CS rate was significantly higher in private compared to public practice: 59.2% and 30.4%, respectively (OR 3.32, 95% CI 2.62 ± 4.21). When only considering elective CSs, a statistically significant difference was found in Robson class 5 between private and public practice, with the latter having more CSs (94.2% and 83.8%, respectively (p = 0.046)). The rate of non-elective CS was significantly lower during nighttime than during daytime (17.2% vs. 21.5%, p < 0.01). During daytime, the higher incidence of CS occurred between 4:00 and 4:59 pm, and during nighttime between 9:00 and 9:59 pm. Failed induction was significantly more common as an indication to CS during daytime when compared to nighttime (p = 0.01). Conclusions: This study identified two non-clinical variables that influenced the CS rate: the type of healthcare setting (private vs. public) and the time of the day. We believe that these indications might be related more to the practitioner attitude, rather than objective delivery complications.
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Keywords:
cesarean section; labor & delivery; obstetrics; private practice; Robson classification; vaginal birth
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MDPI and ACS Style
Strambi, N.; Sorbi, F.; Bartolini, G.M.; Forconi, C.; Sisti, G.; Seravalli, V.; Di Tommaso, M. Non-Clinical Variables Influencing Cesarean Section Rate According to Robson Classification. Medicina 2020, 56, 180. https://doi.org/10.3390/medicina56040180
AMA Style
Strambi N, Sorbi F, Bartolini GM, Forconi C, Sisti G, Seravalli V, Di Tommaso M. Non-Clinical Variables Influencing Cesarean Section Rate According to Robson Classification. Medicina. 2020; 56(4):180. https://doi.org/10.3390/medicina56040180
Chicago/Turabian StyleStrambi, Noemi, Flavia Sorbi, Gian M. Bartolini, Chiara Forconi, Giovanni Sisti, Viola Seravalli, and Mariarosaria Di Tommaso. 2020. "Non-Clinical Variables Influencing Cesarean Section Rate According to Robson Classification" Medicina 56, no. 4: 180. https://doi.org/10.3390/medicina56040180
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