10-group Classification Research Articles

Robson 10-Group Classification: Impact of Race and Ethnicity

Robson 10-Group Classification: Impact of Race and Ethnicity

Examining Cesarean Among Individuals of Advanced Maternal Age in Nurse-Midwifery Care.

Cesarean rates are rising, especially for individuals of advanced maternal age (AMA), defined as aged 35 or older. The Robson 10-Group Classification System (TGCS) facilitates assessment and comparison of cesarean rates among individuals in different settings. In midwifery-led care, in which pregnant people are typically healthier and seek a vaginal birth, it is unknown whether individuals of AMA have different antecedents leading to cesarean compared with younger counterparts. This study aimed to examine antecedents contributing to cesarean using Robson TGCS for individuals across age groups in midwifery care. This study was a secondary analysis of 2 cohort data sets from Oregon Health & Science University (OHSU) and University of Michigan Health Systems (UMHS) hospitals. The samples were individuals in midwifery-led care birthing at either OHSU from 2012 to 2019 or UMHS from 2007 to 2019. A total of 11,951 individuals were studied. Overall cesarean rates were low; however, the rate for individuals of AMA was higher than the rate of their younger counterparts (18.30% vs 15.10%). The Robson groups were similar; however, the primary contributor among AMA individuals was group 5 (multiparous with previous cesarean), followed by group 2 [nulliparous with labor induced or prelabor cesarean], and group 1 [nulliparous with spontaneous labor]. In contrast, the primary contributors for younger individuals were groups 1, 2, and 5, respectively. In addition, prelabor cesarean and induced labor partly mediated the relationship between AMA and cesarean among nulliparous individuals, whereas prelabor cesarean was the key contributor to cesarean among multiparous people. The cesarean rate in midwifery-led care was low. Using Robson TGCS provided additional insight into the antecedents to cesarean, rather than viewing cesarean as a single outcome. Future studies should continue to use Robson TGCS and investigate antecedents to cesarean, including factors influencing successful vaginal birth after cesarean in individuals of AMA.

Analysis of Increasing Cesarean Section Rate by Robson\'s 10-group Classification System in a Tertiary Care Public Charitable Hospital in Haryana

Analysis of Increasing Cesarean Section Rate by Robson\'s 10-group Classification System in a Tertiary Care Public Charitable Hospital in Haryana

Analysis of Cesarean Section Causes Using Robson’s Ten Group Classification System in Selected Hospitals Affiliated to Shiraz University of Medical Sciences: A Cross-sectional Study

Background: Robson’s Ten Group Classification System (RTGCS) is widely used to evaluate, monitor, and compare cesarean delivery (CD) rates within and between delivery service centers. This study aimed to investigate the causes of CD in Shiraz teaching hospitals using RTGCS. Materials and Methods: A cross-sectional study on 1787 pregnant women who underwent CD in selected teaching hospitals in Shiraz, Iran, was selected via convenience sampling within 3 months. The data collection tool was a demographic, midwifery, and fertility information questionnaire completed through interviews and medical records. Subjects’ classification was performed based on midwifery concepts and parameters described in RTGCS. The Robson's 10-group classification is based on simple obstetrical parameters (parity, previous CS, gestational age, onset of labour, fetal presentation, and number of fetuses). Data were analyzed using SPSS software and descriptive tests were used to describe the data. Results: Of the 1787 subjects, 455 (25.5%) had planned CS and 1332 (74.5%) had emergency CS. The most common causes of CD were previous CD (58.6%) and fetal distress (27.6%). Overall, 823 (46.1%) had fetal and placental causes, 1268 (71%) had uterine causes, and 78 (4.4%) had maternal causes. Conclusion: The biggest factors that played a role in the CD rate in the present study were termed multipara women with a history of previous CD. The CD rate and the overall size of this group are still increasing, and as a result, women with a history of a previous CD must be motivated more effectively to have a vaginal birth after cesarean delivery (VBAC).

Robson\'s 10-group Classification System Analysis of Cesarean Deliveries Performed at a Tertiary Care Teaching Institution

Robson\'s 10-group Classification System Analysis of Cesarean Deliveries Performed at a Tertiary Care Teaching Institution

Achievement of appropriate cesarean rates using Robson’s 10-Group classification system in Brazilian private practice

BackgroundIncreasing cesarean section (CS) rates are a global concern because they are related to higher maternal and neonatal complication rates and do not provide positive childbirth experiences. In 2019, Brazil ranked second globally, given its overall CS rate of 57%. According to the World Health Organization (WHO), populational CS rates of 10–15% are associated with decreased maternal, neonatal, and infant mortality rates. This study aimed to investigate whether multidisciplinary care following evidence-based protocols associated with a high motivation of both women and professionals for a vaginal birth leads to less overuse of CS in a Brazilian private practice (PP).MethodsThis cross-sectional study evaluated CS rates by Robson group for women who sought vaginal birth in a private practice in Brazil comparing with Swedish data. Collaborative care of midwives and obstetricians who adopted evidence-based guidelines was offered. CS rates, overall and by Robson group, contribution of each Robson group to the overall CS rate, clinical and nonclinical interventions, vaginal birth, pre-labor CS, and intrapartum CS proportions were estimated. The expected CS rate was calculated using the World Health Organization C-model tool. The analysis used Microsoft Excel and R Studio (version 1.2.1335. 2009–2019).ResultsThe PP overall CS rate was 15.1% (95%CI, 13.4–17.1%) versus the 19.8% (95%CI, 14.8–24.7%) rate expected by the WHO C-model tool. The population included 43.7% women in Robson Group 1 (nulliparous, single, cephalic, at term, spontaneous labor), 11.4% in Group 2 (nulliparous, single, cephalic, at term, induced labor or CS before labor), and 14.9% in Group 5 (multiparous women with previous CS), the greatest contributors to higher CS rates (75.4% of them). The Swedish overall CS rate was 17.9% (95%CI, 17.6–18.1%) in a population of 27% women in Robson Group 1, 10.7% in Group 2, and 9.2% in Group 5.ConclusionsMultidisciplinary care following evidence-based protocols, associated with high motivation of both women and professionals for vaginal birth, may lead to a significant and safe reduction of CS rates even in contexts such as Brazil, with high medicalization of obstetric care and excess CS.

Factors Contributing to Rapidly Increasing Rates of Caesarean Section in Andhra Pradesh, India: A Case-Control Study.

Introduction In some obstetric situations, a caesarean section (CS) can be a crucial, life-saving treatment for both the mother and the infant. Nonetheless, unnecessary CS can raise the risk of morbidity for both. The present study was conducted to study the factors associated with CS deliveryand to study the patterns of utilization of health facilities by pregnant women in the state of Andhra Pradesh in India. Materials and methods A community-based case-control study was done in Mangalagiri mandal, Guntur district, Andhra Pradesh, India in 2022. A total of 268 mothers (134 CS and 134 normal vaginal childbirth) who delivered between 2019 to 2022with at least one biological child less than three years of age were studied. The data was collected using a structured questionnaire. Robson's 10-Group Classification was used to differentiate the type of deliveries of the participants.A p-value less than 0.05 was considered to be significant. Results The mean age of the 268 women studied was 25.49±3.73 years. We found that 47 of the 82 (57.3%) women who went to government healthcare facilities and 87 of the 181 (48.1%) women who went to private healthcare facilities had a CS. Of the total CS studied, approximately 83.5% were emergency CSs. All four mothers who had twins had undergone CS. All women with oblique or transverse fetal lie underwent CS irrespective of parity. On multivariate analysis, participants' education status less than or equal to 10th standard was positively associated withCSandidentification of complications in the third trimester by healthcare provider was significantly protective for CS. Conclusion CS rate reduction necessitates a multi-faceted strategy that includes a variety of programming initiatives. Audits of CS performed as part of health programs and other creative monitoring techniques can be useful tools for assessing the standard of maternity care, particularly emergency CS.

What are the implications of using Robson’s classification system in a Moroccan case study?

Today, cesarean section rates are increasing worldwide for varied and complex reasons. To examine this more closely, several countries have adopted the 10-group classification of cesarean sections, also known as the Robson classification. This classification aims to monitor and compare cesarean section rates in a standard, reliable, and indication-based way. In the vision of improving the quality of care and especially rationalizing cesarean section rates, this descriptive and retrospective study, which lasted ten months, considered a population of parturients who had given birth by cesarean section at the maternity ward of the Cheikh Khalifa Hospital in Casablanca. Using Robson’s classification system, data on deliveries can be compared between different regions of Morocco or between different time periods. This allows assessment of trends, geographic outcomes, and temporal variations in environment-related obstetric outcomes, which can help identify specific maternal health issues and develop targeted policies. We first listed all cesarean deliveries and then classified them into ten groups (Robson’s classification) to highlight the contribution of each group to the overall cesarean rate and to explain the discrepancies for which we proposed recommendations. This study considered 890 cases, of which 541 required a cesarean section, a 61% rate higher than that recommended by the WHO (15%) and the national rate (21%). Robson’s classification identified group 10 as contributing most to the overall cesarean rate (43.4%). Namely, this group included singleton pregnancies with a cephalic presentation, gestational age < 37 weeks, and a scarred uterus. This group’s relative size and cesarean section rate were 68% and 63%, respectively. Cesarean section should be considered a surgical procedure, considering the potential maternal and neonatal risks involved and ensuring that the indication for cesarean section is tangible, based on the Robson classification, among other things.

Use of ten-group Robson Classification in Türkiye to discuss cesarean section trends.

The aim of this study was to analyze and discuss the obstetric data of Türkiye in 2016 according to the Robson 10 Group Classification System. Data related to classification according to The 10-Group Classification System were prospectively collected in university hospitals, private hospitals and public hospitals in 2016 in Türkiye. All pregnant women admitted to labour and delivery wards were included in the study and were classified according to the Robson classification. According to 2016 data in Türkiye, 649,212 of 1,189,578 deliveries were performed by cesarean section and the rate of cesarean section in overall was 54.6%. The cesarean section rates were 38.6%, 68.9%, 70.6%, in public hospitals, university hospitals, private hospitals, respectively (P<0.001). Robson 1 and 2 groups constitute 33.4%, Robson 3 and 4 groups 30.4% and of Robson 5 group 25.1% of all births. The contribution rate of the Robson 5 group to the cesarean section burden is 24.3/54.6%. Türkiye 2016 cesarean section data revealed the necessity of taking initiatives (establishing vaginal birth clinics after cesarean, developing clinical protocols, providing physical and emotional support) to reduce the cesarean section burdens seen in Robson 1, 2 and 5 groups.

A Retrospective Chart Review Study Title of Project: Analysis of Caesarean Sections Using Robson 10-Group Classification System at the Georgetown Public Hospital Corporation, Georgetown, Guyana, South America

Background: The WHO recommends a cesarean delivery rate (CDR) of less than 15%. The CDR at GPHC increased from 17.8% in 2010 to a peak of 26.1% in 2019, nearly twice the WHO recommendation. The purpose of this study is to analyze trends of and the CDR using Robson 10-group classification system (R-TGCS) at a tertiary facility in Guyana (Georgetown Public Hospital Corporation). Methods: This study is a facility based, one-year retrospective chart review of patients who had cesarean deliveries (CDs) between January 1st, 2019 and December 31st, 2019. Pertinent information including maternal age, gestational age at delivery, gravidity and parity and indication for CD, were collected. The overall CDR was calculated and information on each patient was used to allot the patients into one of the ten R-TGCS. The dependent variable was Robson classification group. Results: The total number of CDs for the period was 1641 out of 6277 deliveries above 28 weeks gestational age. Demographically, the most common age range of the cohort was 20-34 years, accounting for 73.8% of the cohort. The mean duration of hospitalization after CD was 3.5 (±3) days. The mean gestational age at delivery was 38 (±2.2) weeks. The most common indications for CD were non reassuring fetal heart tracings (32.2%), previous CD pre-labor (17.9%) and previous CS in labor (9.3%). The most common R-TGCS groups Conclusion: The study showed that groups 5 (multipara with scarred uterus/previous CD), 1 (nullipara in labor) and 3 (multipara without scarred uterus/previous CD) were the major contributors to the overall CDR, with group 5 alone contributing one-quarter to the CDR. Keywords: Robson’s Ten-Group Classification, Cesarean delivery.

Comparison of Cesarean Deliveries in a Multicenter U.S. Cohort Using the 10-Group Classification System.

We sought to (1) use the Robson 10-Group Classification System (TGCS), which classifies deliveries into 10 mutually exclusive groups, to characterize the groups that are primary contributors to cesarean delivery frequencies, (2) describe inter-hospital variations in cesarean delivery frequencies, and (3) evaluate the contribution of patient characteristics by TGCS group to hospital variation in cesarean delivery frequencies. This was a secondary analysis of an observational cohort of 115,502 deliveries from 25 hospitals between 2008 and 2011. The TGCS was applied to the cohort and each hospital. We identified and compared the TGCS groups with the greatest relative contributions to cohort and hospital cesarean delivery frequencies. We assessed variation in hospital cesarean deliveries attributable to patient characteristics within TGCS groups using hierarchical logistic regression. A total of 115,211 patients were classifiable in the TGCS (99.7%). The cohort cesarean delivery frequency was 31.4% (hospital range: 19.1-39.3%). Term singletons in vertex presentation with a prior cesarean delivery (group 5) were the greatest relative contributor to cohort (34.8%) and hospital cesarean delivery frequencies (median: 33.6%; range: 23.8-45.5%). Nulliparous term singletons in vertex (NTSV) presentation (groups 1 [spontaneous labor] and 2 [induced or absent labor]: 28.9%), term singletons in vertex presentation with a prior cesarean delivery (group 5: 34.8%), and preterm singletons in vertex presentation (group 10: 9.8%) contributed to 73.2% of the relative cesarean delivery frequency for the cohort and were correlated with hospital cesarean delivery frequencies (Spearman's rho = 0.96). Differences in patient characteristics accounted for 34.1% of hospital-level cesarean delivery variation in group 2. The TGCS highlights the contribution of NTSV presentation to cesarean delivery frequencies and the impact of patient characteristics on hospital-level variation in cesarean deliveries among nulliparous patients with induced or absent labor. · We report on the cesarean delivery frequencies in a multicenter U.S. . · NTSV gestations (groups 1 and 2) are a primary driver of cesarean deliveries.. · Patient characteristics contributed most to hospital variation in cesarean deliveries in group 2..

CAESAREAN SECTION RATES AT THE HOSPITAL MATERNITY: A CASE STUDY IN MOROCCO USING THE ROBSON CLASSIFICATION SYSTEM

Caesarean section rates continue to rise worldwide, although the reasons appear to be multiple and complex. To better understand and control the phenomenon, many countries have started to use the 10-group classification of Caesarean sections, also known as the Robson classification. This classification will monitor and compare standardized, reliable, consistent, and indication-oriented Cesarean section rates. As part of a quality improvement initiative aimed at rationalizing Caesarean section rates, our descriptive and retrospective study was conducted on a population of parturients who had given birth by Caesarean section at the maternity ward of the CheikhKhalifa Hospital in Casablanca. Our study was conducted over ten months. We listed all Caesarean deliveries and classified them into ten groups (Robsons classification) to identify the contribution of each group to the overall Caesarean rate and to explain potential discrepancies, the analysis of which enabled us to propose recommendations. Our study involved 890 cases, 541 of which required a Caesarean section, a rate of 61%, which is higher than the rate recommended by the WHO (15%) and the national rate (21%). This classification system allowed us to identify group 10 as the most contributing to the overall Caesarean section rate (43.4%). This group included singleton pregnancies with the cephalic presentation, gestational age &lt; 37 weeks, and a scarred uterus. This groups relative size and Caesarean section rate were 68% and 63%, respectively. Caesarean section is a non-negligible surgical procedure with both maternal and neonatal risks. Robsons classification helps to ensure that women who need Caesarean sections receive them.

Obstetric audit of cesarean sections according to M. Robson classification criteria – the experience of St. Petersburg in 2020-2021

An external audit of the childbirth outcomes was conducted in accordance with M. Robsons 10-group classification. The main determinants of indications and the frequency of cesarean section in obstetric medical organizations of St. Petersburg in 2020-2021 were analyzed in order to find effective mechanisms for reducing the frequency of сesarean delivery within the framework of compliance with modern principles of perinatal-oriented obstetrics and the preservation of a womans reproductive health. Possible effective reserves for reducing the frequency of CS are presented: personalized pre-gravidar preparation in high-perinatal risk women groups, personalized approach to methods of pre-induction and induction of labor in high-risk groups patients, rational management of labor in compliance with modern clinical recommendations, wider use of current classical external manual methods for antenatal correction of fetus pelvic presentation, prevention the primary cesarean deliveries, increase in the rate of vaginal deliveries among women with previous cesarean deliveries, optimization of effective antenatal psychological consultation about the delivery methods among pregnant women with breech presentation, previous cesarean deliveries and multiple pregnancy.

Utilizing the Robson 10-Group Classification System as an Audit Tool in Assessing the Soaring Caesarean Section Rates in Ibadan, Nigeria.

Background:The caesarean section (CS) is the most common operation performed globally with increased incidence worldwide.Aim and Objectives:Using the Robson 10-Group Classification System (RTGCS), we aimed to identify women who were the main contributors to the high CS rate (CSR) over a 3-year period at a foremost tertiary health facility.Settings:This study was conducted at the Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria.Materials and Methods:This study is a retrospective study of all women who delivered by CS at the University College Hospital, Ibadan, Nigeria from January 2017 to December 2019. Data were obtained using a structured proforma and women were categorized according to the RTGCS. Data were analysed using SPSS version 21. Descriptive statistics (frequency, percentage, mean) carried out were presented in tables.Results:The CSR was 46.9%. Women in Group 5 (parous women >37 weeks with previous CS and a single foetus in cephalic presentation), Group 1 (nulliparous women >37 weeks with a single foetus in cephalic presentation and spontaneous labour), and Group 10 (women <37 weeks with a single foetus in cephalic presentation) were major contributors to the CSR, with 30.9%, 17.7%, and 13.7%, respectively. Stillbirth rates were highest in Groups 10 (30.3%), 3 (24.4%), and 8 (16.8%). Apgar score <7 at the 5th minute was highest in Groups 5 (29.7%), 10 (17%), and 1 (16.6%).Conclusion:In a bid to reduce caesarean deliveries, efforts should focus on increasing the proportion of vaginal deliveries in these identified groups, especially in women with a history of one CS.

Caesarean birth in women with infertility: population-based cohort study.

ObjectiveCaesarean section (CS) is more common following infertility treatment (IT) but the reasons why remain unclear and confounded. The Robson 10‐Group Classification System (TGCS) may further explain variation in CS rates. We assessed the association between mode of conception and CS across Robson groups.DesignPopulation‐based cohort study.SettingOntario, Canada, in a public healthcare system.Population921 023 births, 2006–2014.MethodsModified Poisson regression produced relative risks (RR) and 95% confidence intervals, comparing the risk of CS among women with (1) subfertility without IT, (2) non‐invasive IT (OI, IUI) or (3) invasive IT (IVF)—each relative to (4) spontaneous conception (SC).Main outcome measuresCS rate according to one of four modes of conception, overall and stratified by each of the TGCS groups.ResultsRelative to SC (26.9%), the risk of CS increased in those with subfertility without IT (RR 1.17, 95% CI 1.16–1.18), non‐invasive IT (RR 1.21, 95% CI 1.18–1.24) and invasive IT (RR 1.39, 95% CI 1.36–1.42). Within each Robson group, similar patterns of RRs were seen, but with markedly differing rates. For example, in Group 1 (nulliparous, singleton, cephalic at ≥37 weeks, with spontaneous labour), the respective rates were 15.0, 19.4, 18.7 and 21.9%; in Group 2 (nulliparous, singleton, cephalic at ≥37 weeks, without spontaneous labour), the rates were 35.9, 44.4, 43.2 and 54.1%; and in Group 8 (multiple pregnancy), they were 55.9, 67.5, 65.0 and 69.3%, respectively.ConclusionsCS is relatively more common in women with subfertility and those receiving IT, an effect that persists across Robson groups.Tweetable abstractCaesarean delivery is more common in women with infertility independent of demographics and prenatal conditions.

The Project Appropriate Birth and a reduction in caesarean section rates: an analysis using the Robson classification system

The objective of this study was to assess caesarean section (CS) rates before and after the implementation of the Project Appropriate Birth (PPA), based on the Robson ten group classification system. A before-and-after study. Maternity hospital in South Brazil. All pregnant women attending from April 2016 to April 2017 (period 1, pre-implementation of PPA) and from June 2017 to June 2018 (period 2, post-implementation of PPA). Maternal and obstetric characteristics were evaluated, including Robson's classification, based on the characteristics of pregnancy and childbirth. A chi-square test and crude and adjusted relative rates were used to analyse the study variables. The significance level was set at 5%. The CS rate for each group, their contribution to the overall CS rate and the differences in these contributions before and after PPA implementation. The CS rates decreased from 62.4 to 55.6%, which represented a 10.9% reduction after the implementation of the PPA. Pregnant women in Robson classification groups 1-4 had a 21.4% reduction in CS rates, ranging from 49.1 to 38.6%. The greatest contributors to the overall CS rates were group 5 and group 2, accounting for more than 60% of the CS deliveries. The study results suggest that Project Appropriate Birth had an impact on the reduction of CS rates, especially in Robson classification groups 1 through 4, which indicates that providing mothers with evidence-based interventions for labour and childbirth assistance contributed to reduce CS rates. The Project Appropriate Birth is an innovative project that has demonstrated promising results, suggesting that interventions based on scientific evidence can lead to real changes in childbirth care, contributing to reduce CS rates. The aim of the PPA is to promote activities to improve childbirth care and encourage vaginal delivery. In this study, 6238 pregnant women admitted to the hospital for delivery were included and classified into one of the Robson 10-group classification. Findings revealed a 10.9% reduction in the overall CS rate and a 21.4% reduction for pregnant women in Robson classification groups 1 through 4, after the implementation of the PPA.

Analysis of Cesarean section delivery in Ain Shams University hospital according to the Robson’s 10-group classification system

Abstract Background Cesarean delivery is increasing worldwide in the last few years, unnecessary CS is a growing problem affecting both developed as well as developing countries. There is no benefits either to mother or neonate when the procedure is not medically indicated. The ideal rate of CS is considered between 10%-15%, beyond which there is no benefits for either mother or fetus. However recent studies showed a much higher rate of CS. WHO proposes that health care facilities use the Robson's 10 group classification system to monitor their CS rates. This classification helps to understand the internal structure of the CS rates at each health facilities, the indications in each group and formulate strategies to reduce these rates. Objectives the aim is to describe the frequency of CS delivery in Ain Shams University Maternity Hospital by Robson classification. And to describe maternal and neonatal outcomes. Methods The study was a descriptive cross sectional study conducted at labor ward of Ain Shams University Maternity Hospital (a tertiary care center). All women delivered by CS during a period of six months were recruited and classified into 10-Robson's groups. The overall CS rate were calculated, and also the contribution of each groups to the overall CS rate. Results The highest contribution to the overall CS was by group five 38.98%, followed by group ten 34.20%. While group 9 was lowest frequency 0.50% of overall CS rates. Conclusion s: The use of Robson’s classification system allows to monitor the CS rates which helps to identify the main contributors for the increasing CS rates, also helps to identify the target groups that may benefit from implementations of interventions for reducing CS rates. Women with previous CS were an important determinant of overall CS rates, reducing primary CS rates, counselling for VBAC, encouraging versions when available, could reduce the CS rates.

Analysis of global trends in caesarean section rates using the Robson classification

The rate of Cesarean section (CS) continues to rise and researchers have no clear understanding of the underlying drivers and consequences. Robson’s 10-group classification is based on simple obstetric parameters (parity, prior CS, gestational age, onset of labor, fetal presentation, and a number of fetuses), which allowed the authors to make an effective evaluation of indicators that lead to an increase in the frequency of abdominal delivery. In the context of the global increase in the frequency of abdominal delivery, further modification of the scale will allow the specialists not only to assess the frequency of CS but also to assess the levels of perinatal morbidity and mortality in the groups that make the most significant contribution to the level of CS. Global trends in the commercialization of childbirth require global approaches to reduce the level of abdominal delivery in the population.

Association between epidural analgesia and indications for intrapartum caesarean delivery in group 1 of the 10-group classification system at a tertiary maternity hospital, Shanghai, China: a retrospective cohort study

BackgroundIn this study, we aimed to determine whether epidural analgesia affects the indications for intrapartum caesarean delivery, such as foetal distress, dystocia, or maternal request, in nulliparous term women with spontaneous labour (Group 1 in the 10-Group Classification System).MethodsWe conducted a retrospective cohort study and collected data from the electronic medical records of deliveries performed in our institution between 1 January 2017 and 30 June 2017. Women conforming to the criterion of Group 1 according to the 10-Group Classification System were enrolled. We compared labour outcomes between women with and without epidural analgesia and analysed the association between epidural analgesia and indications for caesarean by using multivariate logistic regression analysis.ResultsA total of 3212 women met the inclusion criteria, and 2876 were enrolled in the final analyses. Women who received epidural analgesia had a significantly lower intrapartum caesarean delivery rate (16.0% vs. 26.7%, P < 0.001), higher rates of amniotomy (53.4% vs. 42.3%, P < 0.001) and oxytocin augmentation (79.5% vs. 67.0%, P < 0.001), and a higher incidence of intrapartum fever (≥38 °C) (23.3% vs. 8.5%, P < 0.001) than those who did not receive epidural analgesia. There were no significant differences between the groups for most indications, except a lower probability of maternal request for caesarean delivery (3.9% vs. 10.5%, P < 0.001) observed in women who received epidural analgesia than in those who did not. Epidural analgesia was revealed to be associated with a decreased risk of maternal request for caesarean delivery (adjusted odds ratio [aOR], 0.30; 95% confidence interval [CI], 0.22–0.42; P < 0.001); however, oxytocin augmentation was related to an increased risk of maternal request (aOR, 2.34; 95%CI, 1.47–3.75; P < 0.001). Regarding the reasons for the maternal request for caesarean delivery, significantly fewer women complained of pain (0.5% vs. 4.6%, P < 0.001) or had no labour progress (1.3% vs. 3.6%, P < 0.001) among those who received analgesia.ConclusionsAmong the women in Group 1, epidural analgesia was associated with a lower intrapartum caesarean delivery rate, which may be explained by a reduction in the risk of maternal request for an intrapartum caesarean delivery.

Cesarean Section Rate and Perinatal Outcome Analyses According to Robson's 10-Group Classification System.

The cesarean delivery (CD) rate is increasing worldwide. An internationally recognized classification system had been required to analyse the trend and its possible consequences in a standardized manner. The goal of this study was to identify the main contributors to the CD rate at the Medical University of Vienna in an 11-year time period (2003-2013) and to analyse neonatal outcome parameters within the ten Robson categories. This is a retrospective data-analysis of singleton and twin pregnancies in cephalic, breech and transverse presentation with a gestational age between 23 and 42weeks. The cases were divided into ten classes based on the Robson criteria. CD rates and perinatal outcome parameters were analysed within each Robson class. The outcome parameters included: NICU-admission rate and 5min Apgar score values < 7. The overall CD rate was at 44.2%. Within Robson class 5 the CD rate was the highest at 99.1%. Main contributors were Robson class 5 at 20.6%, followed by class 2 at 17.1% and class 8 at 15.0%. Neonatal outcome analyses revealed significant differences between the Robson classes. The main contributors to the CD rate were determined. We suggest reconsidering the frequently applied birth mode especially for Robson class 2, 4, 5 and 8. Lowering the CD rate could be achievable, if a careful delivery management and an individual risk evaluation is provided. It is important to reduce the CD rate in the individual Robson classes under consideration of perinatal outcome parameters, since a reduction should only take place where it is clinically useful and relevant.