Cesarean section in Suriname using robson classification: a two-year nationwide cross-sectional study on rates, risk factors and perinatal outcomes of cesarean section
Abstract Background Optimizing CS performance is a global health priority, given the maternal and perinatal morbidity and mortality associated with both underuse and overuse. This study aims to (1) determine the facility-based CS rate in Suriname and explore which women are most likely to undergo a...
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2025-01-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-024-07009-6 |
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| author | Zita D. Prüst Josephine A. I. Dupont Safir Liesdek Kitty W. M. Bloemenkamp Thomas van den Akker Kim J. C. Verschueren Lachmi R. Kodan |
| author_facet | Zita D. Prüst Josephine A. I. Dupont Safir Liesdek Kitty W. M. Bloemenkamp Thomas van den Akker Kim J. C. Verschueren Lachmi R. Kodan |
| author_sort | Zita D. Prüst |
| collection | DOAJ |
| description | Abstract Background Optimizing CS performance is a global health priority, given the maternal and perinatal morbidity and mortality associated with both underuse and overuse. This study aims to (1) determine the facility-based CS rate in Suriname and explore which women are most likely to undergo a CS and (2) classify all CS by the WHO Robson classification and analyze the perinatal outcomes. Methods An observational, cross-sectional study in Suriname, using nationwide birth registry data that included all hospital births in 2020 and 2021 (≥ 27 weeks of gestation). We used multivariate logistic regression analysis to assess maternal and perinatal characteristics associated with CS. We described cesarean births according to the Robson-10 classification and used descriptive statistics to analyze CS frequencies and perinatal outcomes. Results We analyzed the 18,917 women who gave birth in Surinamese hospitals, with an overall 23.9% CS rate (n = 4522/18,917). The highest CS rates were seen among women with a previous CS (69.3%, aOR 16.2, 95% CI 14.4–18.2), BMI > 40 (47.0%, aOR 5.1, 95% CI 4.0–6.5), newborn with a birthweight from or above 4,000 g (37.3%, 2.2, 95% CI 1.6–3.0) and women giving birth at hospital IV (38.5%, aOR 1.8, 95% CI 1.6–2.0). Hindustani women were more likely to give birth by CS compared to Maroon women (aOR 1.6, 95% CI 1.4–2.0). The largest contribution to the overall CS rate was Robson group 5 (i.e. multiparous women with a previous CS and a singleton term pregnancy in cephalic presentation, 30.5%, n = 1,378). Robson group 2 and 4 (i.e. pre-labor CS, or CS after induction, among term women without previous CS and cephalic presentation) contributed to 21.8% (n = 985) of all CS performed. Robson group 1 and 3 (i.e. during spontaneous labor CS among term women without previous CS and cephalic presentation) accounted for 23.3% (n = 1,052) of all CS cases. Conclusion The facility-based CS rate in Suriname is 24%, with substantial intra-country and inter-hospital variations. These disparities underscore the need for targeted interventions addressing both overuse and underuse of CS. Preventative measures should prioritize promoting safe VBAC, increasing assisted vaginal birth, preventing first-time CS and ongoing monitoring of trends and regular case audits. |
| format | Article |
| id | doaj-art-11401474a864425380baf92dcc791c27 |
| institution | Kabale University |
| issn | 1471-2393 |
| language | English |
| publishDate | 2025-01-01 |
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| series | BMC Pregnancy and Childbirth |
| spelling | doaj-art-11401474a864425380baf92dcc791c272025-01-26T12:57:05ZengBMCBMC Pregnancy and Childbirth1471-23932025-01-0125111010.1186/s12884-024-07009-6Cesarean section in Suriname using robson classification: a two-year nationwide cross-sectional study on rates, risk factors and perinatal outcomes of cesarean sectionZita D. Prüst0Josephine A. I. Dupont1Safir Liesdek2Kitty W. M. Bloemenkamp3Thomas van den Akker4Kim J. C. Verschueren5Lachmi R. Kodan6Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina’s Children Hospital, University Medical Centre Utrecht, Utrecht UniversityDepartment of Obstetrics and Gynaecology, Leiden University Medical CenterDepartment of Neonatology, Academic Hospital Paramaribo (AZP)Department of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina’s Children Hospital, University Medical Centre Utrecht, Utrecht UniversityDepartment of Obstetrics and Gynaecology, Leiden University Medical CenterDepartment of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina’s Children Hospital, University Medical Centre Utrecht, Utrecht UniversityDepartment of Obstetrics, Division Women and Baby, Birth Centre Wilhelmina’s Children Hospital, University Medical Centre Utrecht, Utrecht UniversityAbstract Background Optimizing CS performance is a global health priority, given the maternal and perinatal morbidity and mortality associated with both underuse and overuse. This study aims to (1) determine the facility-based CS rate in Suriname and explore which women are most likely to undergo a CS and (2) classify all CS by the WHO Robson classification and analyze the perinatal outcomes. Methods An observational, cross-sectional study in Suriname, using nationwide birth registry data that included all hospital births in 2020 and 2021 (≥ 27 weeks of gestation). We used multivariate logistic regression analysis to assess maternal and perinatal characteristics associated with CS. We described cesarean births according to the Robson-10 classification and used descriptive statistics to analyze CS frequencies and perinatal outcomes. Results We analyzed the 18,917 women who gave birth in Surinamese hospitals, with an overall 23.9% CS rate (n = 4522/18,917). The highest CS rates were seen among women with a previous CS (69.3%, aOR 16.2, 95% CI 14.4–18.2), BMI > 40 (47.0%, aOR 5.1, 95% CI 4.0–6.5), newborn with a birthweight from or above 4,000 g (37.3%, 2.2, 95% CI 1.6–3.0) and women giving birth at hospital IV (38.5%, aOR 1.8, 95% CI 1.6–2.0). Hindustani women were more likely to give birth by CS compared to Maroon women (aOR 1.6, 95% CI 1.4–2.0). The largest contribution to the overall CS rate was Robson group 5 (i.e. multiparous women with a previous CS and a singleton term pregnancy in cephalic presentation, 30.5%, n = 1,378). Robson group 2 and 4 (i.e. pre-labor CS, or CS after induction, among term women without previous CS and cephalic presentation) contributed to 21.8% (n = 985) of all CS performed. Robson group 1 and 3 (i.e. during spontaneous labor CS among term women without previous CS and cephalic presentation) accounted for 23.3% (n = 1,052) of all CS cases. Conclusion The facility-based CS rate in Suriname is 24%, with substantial intra-country and inter-hospital variations. These disparities underscore the need for targeted interventions addressing both overuse and underuse of CS. Preventative measures should prioritize promoting safe VBAC, increasing assisted vaginal birth, preventing first-time CS and ongoing monitoring of trends and regular case audits.https://doi.org/10.1186/s12884-024-07009-6Cesarean section ratesRobson classificationLatin AmericaMiddle-income countryPerinatal outcomes |
| spellingShingle | Zita D. Prüst Josephine A. I. Dupont Safir Liesdek Kitty W. M. Bloemenkamp Thomas van den Akker Kim J. C. Verschueren Lachmi R. Kodan Cesarean section in Suriname using robson classification: a two-year nationwide cross-sectional study on rates, risk factors and perinatal outcomes of cesarean section BMC Pregnancy and Childbirth Cesarean section rates Robson classification Latin America Middle-income country Perinatal outcomes |
| title | Cesarean section in Suriname using robson classification: a two-year nationwide cross-sectional study on rates, risk factors and perinatal outcomes of cesarean section |
| title_full | Cesarean section in Suriname using robson classification: a two-year nationwide cross-sectional study on rates, risk factors and perinatal outcomes of cesarean section |
| title_fullStr | Cesarean section in Suriname using robson classification: a two-year nationwide cross-sectional study on rates, risk factors and perinatal outcomes of cesarean section |
| title_full_unstemmed | Cesarean section in Suriname using robson classification: a two-year nationwide cross-sectional study on rates, risk factors and perinatal outcomes of cesarean section |
| title_short | Cesarean section in Suriname using robson classification: a two-year nationwide cross-sectional study on rates, risk factors and perinatal outcomes of cesarean section |
| title_sort | cesarean section in suriname using robson classification a two year nationwide cross sectional study on rates risk factors and perinatal outcomes of cesarean section |
| topic | Cesarean section rates Robson classification Latin America Middle-income country Perinatal outcomes |
| url | https://doi.org/10.1186/s12884-024-07009-6 |
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