# Cesarean section trends from 1992 to 2023 in Estonia among singleton term pregnancies: A registry-based study

## TL;DR

This study shows how cesarean section rates in Estonia rose until 2007 and then stabilized, with changes in specific groups of women.

## Contribution

The study provides detailed trends in cesarean sections in Estonia using Robson classification for the first time over a 31-year period.

## Key findings

- Cesarean section rates increased from 6.5% in 1992 to 20.9% in 2007 and remained stable afterward.
- Robson 1+2 (nulliparous women) saw a rise in CS rates, while Robson 5 (previous CS) saw a decline.
- By 2023, over 60% of all CSs were in Robson 1+2 and 5 groups.

## Abstract

The proportion of cesarean section (CS) deliveries has increased worldwide. This study aimed to analyze CS trends in Estonia from 1992 to 2023 in total and according to Robson 1+2 (nulliparous, single cephalic, ≥37 weeks, spontaneous labor, induced or CS before labor) and 5 (previous CS, single, cephalic, ≥37 weeks) criteria.

Data of all deliveries (n=446536) in Estonia from 1992 to 2023 were obtained from the Estonian Medical Birth Registry. During the study period, 73960 births ended in CS. Descriptive characteristics of the study population were divided into two periods (1992–2007 increasing trend; 2008–2023 stable trend). Robson 1+2 and 5 sub-groups were analyzed. Joinpoint regression was used to estimate the change in CS trends in Robson groups over time.

The total proportion of CS increased from 6.5% in 1992 to 20.9% in 2007 and remained stable after that. Robson 1+2 proportion increased from 5% to 21% in 2023, and Robson 5 decreased from 73% to 56%. In 2023, R1+R2 combined with R5 accounted for more than half (63%) of all CSs.

The increase in CS occurred primarily due to the increase in CS rates among nulliparous women with a singleton pregnancy at term. More attention must be given to nulliparous women to prevent CS and maintain vaginal births after CS. To improve the quality of maternity care, it is essential to monitor the indicators of CS based on Robson’s criteria.