Robson分類による帝王切開率に影響を与える非臨床変数

Non-Clinical Variables Influencing Cesarean Section Rate According to Robson Classification.

• Noemi Strambi
• Flavia Sorbi
• Gian Marco Bartolini
• Chiara Forconi
• Giovanni Sisti
• Viola Seravalli
• Mariarosaria Di Tommaso

抄録

:帝王切開（CS）の発生率は世界的に増加しているが、母体や新生児への利益は証明されていない。本研究の目的は、ロブソン分類法を適用しながら、帝王切開率と臨床変数および非臨床変数の両方との関連を評価することである。 本研究は、2012年から2017年の間に第三次医療機関で分娩した妊婦を対象に、公的医療または民間医療のいずれかで分娩した妊婦を対象としたレトロスペクティブ観察研究である。全体的なCS率、およびロブソンのクラス別に分けた選択的CS率と非選択的CS率を決定した。腟分娩とCSの発生率を公的設定と民間設定で比較した。非選択的CSの発生率とその主な適応症の分布を昼間と夜間の間で分析した。69.2%が経膣分娩、30.8%がCSによる分娩であった。ロブソンクラス5が最も多く（23.4％）、次いでクラス2B（16.8％）であった。289例の民間分娩のうち、59.2％がCSであった。公立分娩に比べて民間分娩の方がCS率が有意に高かった。それぞれ59.2％と30.4％であった（OR 3.32、95％CI 2.62±4.21）。選択的CSのみを考慮した場合、ロブソンクラス5では私立と公立の間に統計学的に有意な差が認められ、後者の方がCSが多かった（それぞれ94.2％と83.8％（＝0.046））。非選択的CSの発生率は、日中よりも夜間の方が有意に低かった（17.2％対21.5％、<0.01）。日中は午後4時から4時59分までの間に、夜間は午後9時から9時59分までの間にCSの発生率が高かった。本研究では、CS発生率に影響を与える2つの非臨床的変数を同定した：医療環境の種類（私立 vs 公立）と時間帯。これらの指標は、客観的な分娩合併症というよりも、むしろ開業医の態度に関係しているのではないかと考えられる。

: The incidence of cesarean section (CS) has progressively increased worldwide, without any proven benefit to either the mother or the newborn. The aim of this study was to evaluate the association between CS rates and both clinical and non-clinical variables, while applying the Robson classification system. : This is a retrospective observational study of pregnant women delivering at a tertiary care hospital between 2012 and 2017, either under public or private healthcare. The overall CS rate, and the elective and non-elective CS rate, divided by classes of Robson, were determined. The rate of vaginal deliveries and CSs was compared between the public and private setting. The distribution of incidence of non-elective CSs and their main indications were analyzed between daytime and nighttime. : 18,079 patients delivered during the study period: 69.2% delivered vaginally and 30.8% by CS. Robson class 5 was the most frequent (23.4%), followed by class 2B (16.8%). Of the 289 private practice deliveries, 59.2% were CSs. The CS rate was significantly higher in private compared to public practice: 59.2% and 30.4%, respectively (OR 3.32, 95% CI 2.62 ± 4.21). When only considering elective CSs, a statistically significant difference was found in Robson class 5 between private and public practice, with the latter having more CSs (94.2% and 83.8%, respectively ( = 0.046)). The rate of non-elective CS was significantly lower during nighttime than during daytime (17.2% vs. 21.5%, < 0.01). During daytime, the higher incidence of CS occurred between 4:00 and 4:59 pm, and during nighttime between 9:00 and 9:59 pm. Failed induction was significantly more common as an indication to CS during daytime when compared to nighttime ( = 0.01). : This study identified two non-clinical variables that influenced the CS rate: the type of healthcare setting (private vs. public) and the time of the day. We believe that these indications might be related more to the practitioner attitude, rather than objective delivery complications.