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

Yıl 2020, Cilt: 4 Sayı: 11, 1031 - 1035, 01.11.2020

Emre Başer , Demet Aydoğan Kırmızı , Şafak Özdemirci Taner Kasapoğlu Erhan Demirdağ , Ömer Lütfi Tapısız , Ethem Serdar Yalvaç , Özlem Moraloğlu Tekin

https://doi.org/10.28982/josam.805389

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?

Öz

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.

Anahtar Kelimeler

Primary cesarean, Rising cesarean rates, Robson classification

Kaynakça

• 1. Todman D. A history of caesarean section: from ancient world to the modern era. Aust N Z J Obstet Gynaecol. 2007;47(5):357-61.
• 2. Sewell JE. Cesarean section–a brief history. A brochure to accompany an exhibition on the history of cesarean section at the National Library of Medicine. 1993;30.
• 3. Chong C, Su LL, Biswas A. Changing trends of cesarean section births by the Robson Ten Group Classification in a tertiary teaching hospital. Acta Obst Gyn Scand. 2012;91(12):1422-7.
• 4. Abdel‐Aleem H, Shaaban OM, Hassanin AI, Ibraheem AA. Analysis of cesarean delivery at Assiut University Hospital using the Ten Group Classification System. Int J Gynecol Obstet. 2013;123(2):119-23.
• 5. Santas G, Santas F. Trends of caesarean section rates in Turkey. J Obstet Gynaecol. 2018;38(5):658-62.
• 6. Mylonas I, Friese K. Indications for and risks of elective cesarean section. Dtsch Arztebl Int. 2015;112(29-30):489.
• 7. Clark SL, Belfort MA, Dildy GA, Herbst MA, Meyers JA, Hankins GD. Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery. Am J Obstet Gynecol. 2008;199(1):36. e1-5.
• 8. Farine D, Shepherd D. Classification of caesarean sections in Canada: the Modified Robson criteria. J Obstet Gynaecol Can. 2012;34(10):976-9.
• 9. Hacettepe University Institute of Populatıon Studies. Turkish Population and HealthSurvey, [Online] Available at: http/www.hips.hacettepe.edu.tr/tnsa2008. 2008.
• 10. 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.
• 11. Tilden EL, Cheyney M, Guise J-M, Emeis C, Lapidus J, Biel FM, et al. Vaginal birth after cesarean: neonatal outcomes and United States birth setting. Am J Obstet Gynecol. 2017;216(4):403. e1-8.
• 12. Boyle A, Reddy UM, editors. Epidemiology of cesarean delivery: the scope of the problem. Semin Perinatol. 2012;36(5):308-14.
• 13. Martel M-J, MacKinnon CJ, Committee CPO, Obstetricians So, Canada Go. Guidelines for vaginal birth after previous Caesarean birth. J Obstet Gynaecol Can. 2005;27(2):164.
• 14. Nakamura-Pereira M, do Carmo Leal M, Esteves-Pereira AP, Domingues RMSM, Torres JA, Dias MAB, et al. Use of Robson classification to assess cesarean section rate in Brazil: the role of source of payment for childbirth. Reprod Health. 2016;13(3):128.
• 15. Robson MS. Can we reduce the caesarean section rate? Best Pract Res Clin Obstet Gynaecol. 2001;15(1):179-94.
• 16. Shaaban M, Sayed Ahmed W, Khadr Z, El-Sayed H. Rising cesarean section rates, a patient’s perspective: experience from a high birth rate country. Clin Exp Obstet Gynecol. 2014;41(4):436-9.
• 17. Tapia V, Betran AP, Gonzales GF. Caesarean section in Peru: Analysis of trends using the Robson classification system. PLoS One. 2016;11(2): e0148138.
• 18. Grisaru S, Samueloff A. Primary nonmedically indicated cesarean section (" section on request"): evidence based or modern vogue? Clin Perinatol. 2004;31(3):409-30, vii.
• 19. Signore C, Klebanoff M. Neonatal morbidity and mortality after elective cesarean delivery. Clin Perinatol. 2008;35(2):361-71.
• 20. Gonen R, Tamir A, Degani S. Obstetricians’ opinions regarding patient choice in cesarean delivery. Obstet Gynecol. 2002;99(4):577-80.
• 21. Eyi EGY, Mollamahmutoglu L. An analysis of the high cesarean section rates in Turkey by Robson classification. J Matern Fetal Neonatal Med. 2019:1-11.
• 22. Obstetricians ACo, Gynecologists, Obstetricians ACo, Gynecologists. Special problems of multiple gestation. ACOG educational bulletin. 1998;253:323-33.
• 23. Uzuncakmak C, Guldas A, Aydin S, Var A, Ozcam H. Investigation of cesarean sections at Istanbul Training and Research Hospital Obstetrics and Gynecology Department between 2005 and 2012/SB Istanbul Egitim Arastirma Hastanesi Kadin Hastaliklari ve Dogum Kliniginde 2005-2012 yillari arasinda sezary en ile dogum yapan hastalarin degerlendirilmesi. Istanb Med J. 2013;14(2):112-7.
• 24. Küçük M. Defensive medicine among obstetricians and gynaecologists in Turkey. J Obstet Gynaecol. 2018;38(2):200-5.
• 25. Rauf B, Nisa M, Hassan L. External cephalic version for breech presentation at term. J Coll Physicians Surg Pak. 2007;17(9):550-3.
• 26. Collaris R, Tan P. Oral nifepidine versus subcutaneous terbutaline tocolysis for external cephalic version: a doubleblind randomised trial. BJOG: An International Journal of Obstetrics & Gynaecology. 2009;116(1):74-81.
• 27. Shaaban MM, Ahmed WS, Khadr Z, El-Sayed HF. Obstetricians’ perspective towards cesarean section delivery based on professional level: experience from Egypt. Arch Gynecol Obstet. 2012;286(2):317-23.
• 28. Josefsson A, Gunnervik C, Sydsjö A, Sydsjö G. A comparison between Swedish midwives and obstetricians & gynecologists opinions on cesarean section. Matern Child Health J. 2011;15(5):555-60.