Swiss caesarean section rates according to Robson's Ten-Group Classification System: an observational study.

Abstract

Study aims: Robson's Ten-Group Classification System (TGCS) was proposed to describe caesarean section rates by ten patient-centred risk-specific groups. The aim of the study was to describe Swiss caesarean section rates according to this classification, further stratifying it according to region and type of structure where delivery took place.  We also aimed to compare our results to the standard caesarean section rates, recommended by the World Health Organization (WHO).

Methods: An observational study including all women delivering in health facilities in Switzerland in the period 2014-2021. A total of 695,733 deliveries were included. Core variables used for classification were semi-automatically generated using routine data provided by the Swiss Federal Statistics Office. Caesarean section rates were reported according to the TGCS. Data were also stratified according to each of the 26 Swiss cantons, as well as to the typology of hospital where delivery took place.

Results: The major relative contributors to the overall caesarean section rate were Group 2 (nulliparous, above 37 weeks, with induction) and Group 5 (women with previous caesarean section, above 37 weeks with a singleton pregnancy), respectively accounting for 20.7% and 30.1% of all caesarean sections. We also showed that the Swiss population was similar to the population considered in the WHO recommendation. Nonetheless, the caesarean section rate among our population exceeded that suggested by the WHO recommendations, being respectively of 44.4% vs 39.9% and 86.0% vs 74.4% for Groups 2 and 5. Large variations were detected in the caesarean section rate when looking at the different cantons, ranging from 29.8% to 59.6% for Group 2 and between 58.0% and 100.0% for Group 5.

Conclusion: Routine data collection allowed us to describe caesarean section rates throughout Switzerland according to the TGCS. The Swiss caesarean section rate was higher than the caesarean section rate recommended by the WHO, even though the population characteristics were comparable. Substantial differences were found when stratifying caesarean section rates according to the canton, as well as to the type of structure where delivery took place.