Türkiye’de sezaryen oranlarının Robson ten group classification sistemi ile değerlendirilmesi; sezeryan oranları nasıl azaltılır?

Öz

Amaç: Sezaryen (CS) oranları tüm dünyada olduğu gibi Türkiye’de son on yılda ciddi bir artış göstermiştir. Dünya Sağlık Örgütü, CS oranlarının analizini ve karşılaştırılmasını kolaylaştırmak için Robson10- Group Sınıflandırma Sistemini (TGCS) küresel bir standart olarak onaylamıştır. Bu çalışmanın amacı Türkiye’de TGCS ile CS oranlarının analiz edilerek CS’yi azaltma stratejilerinin belirlenmesidir. Yöntemler: Bu çalışma, 1 Ocak 2011 ve 31 Aralık 2014 tarihleri arasında üçüncü basamak bir merkezde doğum yapan kadınların kayıtları toplanarak yapılan retrospektif bir kohort çalışması olarak planlandı. Tüm veriler hastane veri tabanından ve hasta dosyalarından elde edildi. Hastalar TGCS kullanılarak gruplandırıldı. Her grubun CS oranlarına katkısı belirlendi. Bulgular: 2010-2014 tarihleri arasında 63.476 doğumdan 25.653'ü sezaryen ile gerçekleştirildi. CS oranı yıllar içinde istatistiksel olarak anlamlı artış göstermekteydi (P<0,001). TGCS ye göre bu artışa en büyük katkı Sınıf 5 grubuna aitti. Bu grup, 2011 yılında sezaryen yapılan tüm hastaların %40,7’sini (2073/5096), 2012 yılında %37,3’ünü (2045/5480), 2013 yılında %27,1’ini (1859/6857), 2014 yılında ise %36,8’ini (3025/8220) oluşturmaktaydı. Çalışma verilerinin değerlendirildiği yıllar içinde Sınıf 1, 3 ve 10’daki hasta oranları anlamlı olarak artarken, Sınıf 2 ve 4’teki oranların azalmakta olduğu görüldü (P<0,001). Sonuç: 2011’de %36 olan CS oranının, 2014’te %44’e yükseldiği saptanmıştır. TGCS ye göre CS oranlarındaki artışı önleme stratejileri Sınıf 1, 3 ve 5 hastalarının azaltılması yönünde geliştirilmelidir. Bu çerçevede CS oranlarını azaltacak stratejiler kadın hastalıkları doğum uzmanlarının uygulamaları ve ülkelerin sağlık politikalarının düzenlenmesiyle oluşturulabilir.

Anahtar Kelimeler

• Primer sezaryen
• Artan sezaryen oranları
• Robson sınıflaması

An evaluation of cesarean rate in turkey by the Robson ten group classification system: How to reduce cesarean rates?

Abstract

Aim: Caesarean section (CS) rates, as is the case in the world, showed a significant increase in Turkey over the last decade. The World Health Organization has approved the Robson10-Group Classification System (TGCS) as a global standard to facilitate the analysis and comparison of CS rates. The present study aimed to analyze the TGCS to CS ratio in Turkey and determine CS reduction strategies. Methods: The data for this retrospective cohort study were collected from the records of women who gave birth between January 1, 2011 and December 31, 2014 in a tertiary center. All data were obtained from the hospital database and patient files. The patients were grouped using TGCS. The contribution of each group to CS ratios was determined. Results: Between 2011 and 2014, a total of 25,653 out of 63,476 deliveries were performed by CS. It was determined that the CS rate was 36% in 2011 and increased to 44% in 2014 (P<0.001). According to TGCS, the biggest contribution to this increase belonged to the Class 5 group. This group included 40.7% (2073/5096) of all patients undergoing cesarean section in 2011, 37.3% (2045/5480) in 2012, 27.1% (1859/6857) in 2013, and 36.8% (3025/8220) in 2014. While the rates of patients in Class 1,3 and 10 increased significantly over the years in which the study data were evaluated, rates in Class 2 and 4 decreased (P<0.001). Conclusion: According to TGCS, strategies to prevent the increase in CS ratios should be developed to reduce Class 1, 3 and 5 patients. In this context, strategies to reduce CS ratios can be established through obstetric practices and the health policies of countries.

Keywords

• Primary cesarean
• Rising cesarean rates
• Robson classification

Kaynakça

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