Trends in caesarean section rates in Europe from 2015-2019 using Robson's Ten-Group Classification System: A Euro-Peristat registry study

OBJECTIVE: To assess changes in caesarean section (CS) in Europe from 2015-2019 and utilise the Robson Ten Group Classification System (TGCS) to evaluate the contribution of different obstetric populations to overall CS rates and trends METHODS: This was an observational study utilising routine population birth data from 28 European countries participating in the Euro-Peristat network. We included all births ≥22 weeks gestational age, from 2015 to 2019. A federated model used individual-level data from routine sources in each country formatted to common data model to generate anonymous, aggregate data tables on yearly CS rates and the Robson TGCS classification. We computed the Robson group-specific relative size, CS rate, relative and absolute contribution to overall CS rate RESULTS: Among the 28 European countries, CS rates (2015: 16.0-55.9%; 2019: 16.0-52.2%) and trends varied (-3.7-+4.7%; 9 countries decreasing, 7 stable [ ≤ ±0.2], 12 increasing). Using the Robson Classification (17 countries), in most countries, labour induction increased (Groups 2a, 4a), while multiple pregnancies (Group 8) decreased. In countries with decreasing overall CS rates, CS tended to decrease in most Robson groups, while in countries with increasing overall CS rates, CS tended to increase in most Robson groups. In countries with the greatest increase in CS rates (>1%), absolute contributions of Groups 1 (nulliparous term cephalic singletons, spontaneous labour), 2a and 4a, 2b and 4b (prelabour CS), and 10 (preterm cephalic singletons) to overall CS tended to increase. CONCLUSIONS: Analysis of the Robson Classification shows varying CS trends and rates across Europe. Comparisons between European countries, particularly those with divergent trends, could provide insight into strategies to reduce CS without indication.