Abstract
BackgroundRising caesarean section rates is a concern worldwide. This study aimed to use Robson’s ten group classification to identify which groups of women were contributing most to the rising caesarean section rates in Malaysian tertiary hospitals and to compare between hospitals, using a common standard set of variables.MethodsA 5-year (2011–2015) cross-sectional study was conducted using data from the Malaysian National Obstetrics Registry (NOR). A total of 608,747 deliveries were recorded from 11 tertiary state hospitals and 1 tertiary hospital from the Federal territory.ResultsDuring the study period, there were 141,257 Caesarean sections (23.2%). Caesarean sections in Group 1 (nulliparous term pregnancy in spontaneous labour) and Group 3 (multiparous term pregnancy in spontaneous labour) had an increasing trend from 2011 to 2015. The group that contributed most to the overall caesarean section rates was Group 5 (multiparous, singleton, cephalic≥37 weeks with previous caesarean section) and the rates remained high during the 5-year study period. Groups 6, 7 and 9 had the highest caesarean section rates but they made the smallest contribution to the overall rates.ConclusionsLike many countries, the rate of caesarean section has risen over time, and the rise is driven by caesarean section in low-risk groups. There was an important hospital to hospital variation. The rise in caesarean section rates reflects a globally disturbing trend, and changes in policy and training that creates a uniform standard across hospitals should be considered.
Highlights
Rising caesarean section rates is a concern worldwide
Changes in policy and training that creates a uniform standard across hospitals should be considered
The Caesarean section (CS) rate in each year for each of the 12 hospitals is shown as grey lines in Fig. 2, with the aggregate hospital rate shown as a black line
Summary
Rising caesarean section rates is a concern worldwide. This study aimed to use Robson’s ten group classification to identify which groups of women were contributing most to the rising caesarean section rates in Malaysian tertiary hospitals and to compare between hospitals, using a common standard set of variables. Given that the rate of clinically required CS may vary for demographic reasons between populations. An analysis of Malaysian tertiary hospital data, showed substantial variation in CS rates (not accounted for by demographic variation) from as low as 16% to more than 32% [7, 8]. This kind of variation within the context of a single hospital system within one country is a cause for potential concern and invites investigation [9]
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