Impact of national guidelines on the cesarean delivery rate in France: A 2010–2016 comparison using the Robson classification

Abstract

ObjectiveFrench national guidelines on indications of pre-labor cesarean delivery and management of women with a previous cesarean delivery (CD) were published in 2012. Our aim was to assess if these guidelines have impacted the global CD rate in France and the CD rate in specific groups according to the Robson classification, using the national perinatal population-based surveys of 2010 and 2016. MethodsWomen included in the French National Perinatal Surveys in 2010 and 2016 were classified using maternal characteristics and obstetrical history in 12 groups according to Robson’s classification (N = 14176 in 2010 and N = 13057 in 2016). We estimated relative size, CD rate and contribution of each group to the global CD rate in 2010 and 2016. Then, we compared the 2 survey years. We analyzed the population characteristics, timing and indications of CD in the groups with significant changes between the two survey years. ResultsThe global CD rate was 20.5 % in 2010 and 19.5 % in 2016 (p = 0.027), with a lower pre-labor CD rate (10.9 % versus 9.2 %, p < 0.001). Despite an increasing of maternal age in 2016, we observed a decrease of the relative size of group 2b (nulliparous, singleton, cephalic, term, pre-labor CD): 1.1 % in 2010 versus 0.8 % in 2016 (p = 0.008). Group 5 (previous CD, singleton, cephalic, ≥37 weeks) was the higher contributor to the global CD rate in both 2010 and 2016 (contribution: 5.8 % of the 20.5 % CD rate and 5.4 % of the 19.5 % CD rate, respectively). Despite an increase of BMI in this group, its CD rate significantly decreased between the two years (61.2 % in 2010 versus 55.1 % in 2016, p = 0.001). ConclusionIn France, CD rates have decreased between 2010 and 2016, among women having a pre-labor CD and women with a previous CD, in accordance with national guidelines. National guidelines can help mode of delivery decision-making of physicians and impact the national CD rates.