Examining Cesarean Delivery Rates Using the Robson's Ten-group Classification.

Abstract

To examine Cesarean delivery rates based on the Robson's Ten-group classification system (TGCS), over a 10-year period. All Vaginal Deliveries and cesarean sections (CSs) performed over a 10-year period from 2004 to 2013 were included in the analysis. The data were compiled according to Robson's TGCS of cesarean section for every year. Risk Ratios (crude RRs) with 95% confidence intervals for delivery by cesarean section were calculated for each Robson's group. The TGCS was easily applied in this large dataset of 40,086 deliveries. The 10-year overall cesarean section rate (CSR) was 25.17%. Groups 1 and 3 represented 60% of the total obstetric population. The largest contributions to the total CSR are group 1 (37.62%) and group 5 (17.06%). Group 3 which was the second largest group contributed 15% to the overall CSR. Group 2 and group 4 had high group CSRs of 47.28 and 34.74% respectively, although the total group size was small (n=1375;3.43%). Maternal age and presentation were found to have an independent association with mode of delivery on logistic regression. The Ten-group classification helped to identify the main groups of subjects who contribute most to the overall CSR. It also helped to identify subgroups requiring closer monitoring for more in-depth analyses of the indications for caesarean section. It is important to focus on the first four TGCS groups which constitute about 75% of all deliveries. It is in the low-risk groups that one is likely to find the highest and most inappropriate indications for cesarean sections.