War-associated changes in caesarean delivery patterns: a Robson classification analysis of 10,859 deliveries in Ukraine
4 affiliations
- 1Odesa National Medical University; Maternity Hospital No. 5 of the Odesa City Council, Odesa
- 2Odesa National Medical University, Odesa
- 3Maternity Hospital No. 5 of the Odesa City Council; Odesa National Medical University, Odesa
- 4Maternity Hospital No. 5 of the Odesa City Council, Odesa
Abstract
Objective of the study: to evaluate war-associated changes in cesarean delivery (CD) using the Robson Ten Group Classification System (TGCS) and provide evidence to support optimization of obstetric care in conflict-affected settings. Materials and methods. A retrospective comparative study was conducted, including two cohorts: pre-war (2017–2019) and wartime (2022–2024) in Ukraine. Standardized definitions were applied in accordance with STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. A total of 10,859 deliveries were analyzed. Results. The study included 6,020 deliveries in the pre-war period and 4,839 during wartime. Despite a reduction in total births, the overall CD rate increased from 36.86% to 42.96% (χ² = 41.78; p < 0.001; relative risk (RR) = 1.17; 95% confidence interval (CI) 1.11–1.22), reaching 51.40% in 2024. The most pronounced increase in primary CD was observed among women with an unscarred uterus (Robson Groups 1–4), rising from 23.9% to 47.5% (RR = 1.99; 95% CI 1.85–2.13; p < 0.001). In Group 1, the CD rate increased from 17.14% to 35.82% (RR = 2.09; 95% CI 1.87–2.34), and in Group 3 from 6.36% to 20.88% (RR = 3.28; 95% CI 2.57–4.19). CD rates remained consistently high among women with a previous cesarean section (Group 5: 99.44% vs. 97.14%). In contrast, a decrease in CD rates was observed in breech pregnancies (Group 6: 98.87% vs. 88.51%; Group 7: 100% vs. 68.42%; p < 0.001) and in multiple pregnancies (Group 8: 100% vs. 71.43%; p < 0.001). Conclusions. Prolonged wartime conditions were associated with substantial changes in CD patterns, characterized primarily by an increase in primary surgery among women traditionally considered at low obstetric risk. These findings suggest that war-related contextual factors may influence obstetric decision-making beyond changes in obstetric case mix. Continuous monitoring using the Robson TGCS may help identify shifts in obstetric practice during humanitarian crises and support strategies to reduce unnecessary primary CD.
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BibTeX
@article{manasova2026warassociated,
title = {{War-associated changes in caesarean delivery patterns: a Robson classification analysis of 10,859 deliveries in Ukraine}},
author = {G.С. Manasova and O.V. Zhovtenko and I.V. Shpak and M.V. Shapoval and D.M. Zhelezov and Y.O. Stasii and N.V. Kuzmin},
journal = {Репродуктивная эндокринология},
year = {2026},
month = sep,
doi = {10.18370/2309-4117.2026.85.8-15},
url = {https://doi.org/10.18370/2309-4117.2026.85.8-15},
note = {CC BY},
}
RIS
TY - JOUR
TI - War-associated changes in caesarean delivery patterns: a Robson classification analysis of 10,859 deliveries in Ukraine
AU - G.С. Manasova
AU - O.V. Zhovtenko
AU - I.V. Shpak
AU - M.V. Shapoval
AU - D.M. Zhelezov
AU - Y.O. Stasii
AU - N.V. Kuzmin
PY - 2026
DA - 2026/09/01
JO - Репродуктивная эндокринология
DO - 10.18370/2309-4117.2026.85.8-15
UR - https://doi.org/10.18370/2309-4117.2026.85.8-15
AB - Objective of the study: to evaluate war-associated changes in cesarean delivery (CD) using the Robson Ten Group Classification System (TGCS) and provide evidence to support optimization of obstetric care in conflict-affected settings. Materials and methods. A retrospective comparative study was conducted, including two cohorts: pre-war (2017–2019) and wartime (2022–2024) in Ukraine. Standardized definitions were applied in accordance with STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. A total of 10,859 deliveries were analyzed. Results. The study included 6,020 deliveries in the pre-war period and 4,839 during wartime. Despite a reduction in total births, the overall CD rate increased from 36.86% to 42.96% (χ² = 41.78; p < 0.001; relative risk (RR) = 1.17; 95% confidence interval (CI) 1.11–1.22), reaching 51.40% in 2024. The most pronounced increase in primary CD was observed among women with an unscarred uterus (Robson Groups 1–4), rising from 23.9% to 47.5% (RR = 1.99; 95% CI 1.85–2.13; p < 0.001). In Group 1, the CD rate increased from 17.14% to 35.82% (RR = 2.09; 95% CI 1.87–2.34), and in Group 3 from 6.36% to 20.88% (RR = 3.28; 95% CI 2.57–4.19). CD rates remained consistently high among women with a previous cesarean section (Group 5: 99.44% vs. 97.14%). In contrast, a decrease in CD rates was observed in breech pregnancies (Group 6: 98.87% vs. 88.51%; Group 7: 100% vs. 68.42%; p < 0.001) and in multiple pregnancies (Group 8: 100% vs. 71.43%; p < 0.001). Conclusions. Prolonged wartime conditions were associated with substantial changes in CD patterns, characterized primarily by an increase in primary surgery among women traditionally considered at low obstetric risk. These findings suggest that war-related contextual factors may influence obstetric decision-making beyond changes in obstetric case mix. Continuous monitoring using the Robson TGCS may help identify shifts in obstetric practice during humanitarian crises and support strategies to reduce unnecessary primary CD.
SN - 2309-4117
SN - 2411-1295
ER -