Caesarean section rate trend in the Calabria Region according to Robson's Ten Group Classification System: a population-based study

Abstract

Background: The global increase in caesarean section (CS) rates raises concerns about maternal and neonatal outcomes. Italy, with one of the highest CS rates in Europe, especially in the Calabria Region, faces challenges in reducing this trend. The Calabria Region has joined the "Easy-Net" Network Program (NET-2016-02364191) for the evaluation of audit & feedback (A&F) interventions to reduce CS rate. This study aims to analyze past trends, describe maternity unit (MU) characteristics, and provide a baseline assessment of CS rates using the Robson's Ten Group Classification System (TGCS).

Methods: This population-based cross-sectional study analyses CS rates using data from National and Regional Birth Registers, categorizing women with the Robson's TGCS.

Results: From 2017 to 2020, 54,041 births were registered in the Calabria Region. The results reveal a fluctuating CS rate (36.2%-38.1%) with variations from different Robson groups. Group 5 (previous CS) consistently increased, impacting overall rates, while Group 1 (nulliparous, cephalic, spontaneous labor) decreased. The groups 2b (6.8%-4.8%) and 4b (2.5%-1.8%), which represent respectively nulliparous and multiparous women with pre-labour CS, showed high rates despite their reduction over the years. In 2020, variations in CS rates across 11 MUs highlighted complexities, emphasizing the need for localized interventions.

Conclusions: The study highlights the critical issue of high CS rates in the Calabria Region. It is advisable to monitor and reduce unnecessary CSs through evidence-based interventions, taking advantage of the Robson classification and an A&F strategy. These findings guide future efforts to enhance CS appropriateness and improve maternal and child health outcomes.