Cesarean delivery rates using Robson classification system in Ireland: What can we learn?

Abstract

ObjectiveIt has been proposed that the Robson Ten-Group Classification System be used as a global standard for assessing, monitoring and comparing cesarean delivery (CD) rates within and between maternity services. Our objective was to compare the change of CD rates within the 10-Group Classification System in our institution over 10 years. Study designFrom 2005–2014 inclusive data was collected prospectively and all women were classified using the obstetric concepts and parameters described in the Ten-Group Classification System. Linear regression and weighted Least Squares regression analyses were used to analyze trends over time. ResultsDuring 2005–2014 inclusive, 88,004 mothers delivered 89,649 babies ≥500 g. Over the 10 year period there was an increase in CD rate from 18.3% to 23.5%, with a linear increase in CD rate by 0.6% annually (95% CI:0.52, 0.75;p < 0.001). The main contribution to the increase in the CD rate was Group 2a (induced single cephalic nulliparous women at term), Group 2b (pre-labor single cephalic nulliparous women at term) and Group 5 (single cephalic multiparous women at term with a previous CD). No increase in CD rate was noted in Group 1 (single cephalic nulliparous women presenting in spontaneous labor at term). The percentage of women ≥35 years of age increased from 28.4% to 39.8% over the study period (0.98% per year; 95% CI:0.64, 1.33;p < 0.001). ConclusionThe driving force for the increase in CD in the National Maternity Hospital has been induction of labor and pre-labor CD in nulliparous women with a single cephalic pregnancy at term. This inevitably results in a larger population of women with a previous CD and therefore a secondary contribution to the increase in the overall CD rate.