Group Classification System Research Articles

Indications of Induction and Caesarean Sections Performed Using the Robson Classification in a University Hospital in Spain from 2010 to 2021.

Background: The Robson Ten Group Classification System (RTGCS) enables the assessment, monitoring, and comparison of caesarean section rates both within healthcare facilities and between them, and the indications of caesarean sections (CS) performed in a maternity ward. The aims of the present study were to conduct an analysis to assess the levels and distribution of birth from a descriptive approach by CS in La Ribera University Hospital (Spain) between 2010-2021 using the Robson classification; to describe the indications for the induction of labour and the causes of caesarean sections performed; and to examine the association between the induction of labour and CS birth. Methods: A retrospective study between 1 January 2010 and 31 December 2021. All eligible women were classified according to the RTGCS to determine the absolute and relative contribution by each group to the overall CS rate. The odds ratio (OR) of the variables of interest was estimated by logistic regression. In an analysis of the subgroups, the level of significance was adjusted using the Bonferroni method. Results: 20,578 women gave birth during the study period, 19% of them by CS. In 33% of births, induction was performed, and the most common cause was the premature rupture of membranes. Group 2 (nulliparous with induced labour/elective CS before labour) accounted for the largest contribution to the overall rate of CS (31.5%) and showed an upward trend from 23.2% to 39.7% in the time series, increasing the CS rate by 6.7%. The leading cause of CS was suspected fetal distress, followed by induction failure. Conclusions: In our study, Robson Group 2 was identified as the main contributor to the hospital's overall CS rate. Determining the causes of induction and CS in a population sample classified using the RTGCS enables the identification of the groups with the greatest deviation from the optimal rate of CS and the establishment of improvement plans to reduce the overall rate of caesarean sections in the maternity unit.

A Step Toward Better Audit: The Robson Ten Group Classification System for Outcomes Other Than Cesarean Section

(Acta Obstet Gynecol Scand. 2022;101:827–835) The Robson groups, a classification system created in 2001 by Michael S. Robson, is utilized for the review of cesarean delivery (CD) rates across different groups of parturients based on parity, number of fetuses, fetal presentation, gestational age, and mode of onset of labor. This study investigated if the Robson Ten System can be extended to studying and comparing other attributes of delivery besides CD such as obstetric and sphincter injury (OASIS), operative vaginal delivery (OVD), Apgar scores, and postpartum hemorrhage.

Profile of cesarean section during COVID-19 using Robson ten group classification system in a tertiary teaching hospital, Nepal: a cross-sectional study.

A hospital-based cross-sectional study was conducted among women admitted for delivery in the Department of Obstetrics and Gynecology of a tertiary teaching hospital during the second wave of COVID-19 (1 May 2021-30 July 2021). Convenience sampling technique was applied and 1350 women were categorized into groups using Robson ten group classification system. Group size, group caesarean rate, absolute and relative contribution of each group to overall caesarean rate were calculated. Out of 1350 total deliveries during COVID-19, lower segment caesarean section was done in 446 (33.04%) (30.53-35.55 at 95% Confidence Interval). Major indication for caesarean section was previous caesarean in 185 (41.48%). Most women 202 (45.29%) were from the age group 24-30 years and gestational age between 37 and 42 weeks. Major contributor to the overall caesarean section rate was Robson group 5 (37%). This study showed higher prevalence of caesarean section delivery rate during COVID-19 pandemic than that compared with 2016 national statistics of Nepal. Despite of several challenges brought by the pandemic, pregnant women were still able to access the emergency obstetric care services in the Eastern part of Nepal. However, future studies should focus on exploring the situation in rural areas too.

Assessment Of Caesarean Section Rate Using Robson Ten Group Classification System In A Tertiary Care Hospital: A Cross Sectional Study.

The growing rate of caesarean section is a major concern for quality of maternal life and public health. Concerns about such increases prompted the WHO to recommend Robson ten group classification system for assessing the Caesarean Section rate. The present study's aim was to assess the caesarean rate using Robson's ten group classification system and highlighted the reliable information system, in turn, helps to construct interventions to reduce avoidable caesareans. This cross sectional study was carried out on 5796 women who delivered from 25th November 2021 to 24th November 2022 in Jinnah Post Graduate medical Centre Karachi. Data was collected from the women admitted for delivery using Robson's Pro forma. Relative size and caesarean rate of each group and overall caesarean section rate was calculated. Of the total 5796 deliveries, 2141 (36.9%) were caesarean deliveries and 3655 (63.1%) had normal deliveries. Out of Robson's ten groups system, Group 10 had a higher contribution of 705 (12.2%) to the overall caesarean rate followed by group 5 had 627 (10.8%). The contributing prevalence of Group 1, 2, 3, 4, 6, 7, 8 and 9 were 122 (2.1%), 317 (5.5%), 50 (0.87%), 167 (2.9%), 42 (0.72%), 35 (0.6%), 49 (0.85%) and 27 (0.46%) respectively. Our study concluded that Group 10 and 5 were the most responsible for the whole Caesarean Section rate. In all contributing groups, there is a need to identify the indications and to sub classify these groups further so that preventable caesarean sections can be avoided by reducing these factors.

Weed Species Composition in Paddy Field of Usur Town, Bade Local Government, Yobe State, Nigeria

Farmers are eager to know the various types of weeds in paddy fields. This will help in choosing the best weed management practice for effective weed control as well as reducing rice yield losses. The objectives of the study are to identify the weeds species affecting the rice field, to assess the composition of weeds species, to classify the weed species into different families, genera, species, common names, Hausa names, lifecycles, life forms, native/exotic species, propagation and uses, and to determine the dominant weed species. Random vegetation surveys were conducted. Weeds observed were photographed, and prepared as herbarium specimens. Standard key manuals and checklists were utilized for weed identification and later organized using the Angiosperm Phylogeny Group (APG) classification system. A total number of 72 plants species distributed within 16 families and 50 genera were inventoried. The annuals (66.67%) were the dominant weed followed by perennials (33.33%) while biennials were the least. The broad leaves were the dominant weed (44.61%) identified followed by Poaceae (27.7%) and Sedges (11.11%). Results obtained from this study could be useful in choosing the best management practice and in making a decision on the choice of herbicides and directing research towards improved weed control measures.

Cesarean Section Trends In The Tertiary Hospital – A Description Study With The Robson Classification

Introduction: The high incidence of Cesarean Section (CS) in Indonesia causes morbidity andmortality for mothers and babies and is not in line with efforts to reduce maternal and infant mortalityaccording to the 2024 RPJMN. This study aims to provide an overview of the criteria for C-sectionaccording to the Robson Group Classification System for CS indications at the suburban area level.Methods: his study used medical record data from patients who underwent childbirth at RSIAPermata Bunda, Solok City, West Sumatra, from July to December 2021, where each patient wasincluded in the CS criteria group according to the Robson Group Classification System for CSindications. After that, all data groups were analyzed.Results: The CS rate at RSIA Permata Bunda for the period July 2021-December 2021 is 80.65%.This is in accordance with tiered referral conditions at level 1 health facilities.In the CS Robson criteria, criterion 5 occupies the highest position in the percentage of AbsoluteContribution (29.08) and Relative Contribution (36.05). This criterion includes all multiparousdeliveries, singleton fetuses, and pregnancies >37 weeks with at least 1 history of uterine surgery(uterine scar).In the Robson 2 group, Absolute Contribution (18.33) and Relative Contribution (22.73) were thesecond highest. This group includes all nulliparous pregnancies with singletons, >=37 weeks, with anindication for induction or surgery prior to delivery.Conclusion: The Robson Group Classification System for CS indications is considered to be used indetermining the description of CS criteria in tertiary hospitals. This criterion can well help theHospital to describe and analyze the high rate of C-section

Evaluation of Cesarean Deliveries by using Ten Group Classification System in a Tertiary Care Centre: A Cross-Sectional Study

Introduction: Cesarean section has three times increased risk of maternal and fetal morbidities compared to vaginal delivery. The rising trend of cesarean deliveries across the globe led the WHO to recommend the use of the Ten Group classification system to monitor cesarean rate over time as well as between facilities. The cesarean section rate is increasing in our centre, so the study was conducted to evaluate the cesarean deliveries and identify the group with a major contribution to the cesarean rate so that policies could be formulated to decrease it in our centre.
 Method: It was a cross-sectional descriptive study conducted in the Department of Obstetrics and Gynecology, Manipal Teaching Hospital, Nepal for six months after ethical approval. All women who delivered at or beyond 28 weeks were included in the study after their consent and were classified according to Robson's classification based on their obstetric parameters. The total cesarean section rate, the size of each group, the cesarean rate in each group and the absolute contribution of each group to the overall cesarean rate were calculated and analyzed.
 Results: Out of 711 deliveries during the study period, the cesarean rate was 51% (n=362). Group 1(26%) was the major obstetric population followed by Group 3(20%) and Group 2(16%). Group 5(10.97%) had a major contribution to the overall cesarean rate followed by Group 1(10.68%) and Group 2 (9.7%).
 Conclusion: The cesarean rate in our study was high and it could be decreased by encouraging the trial of labor after cesarean and revisiting the indication of induction and cesarean in Group 1 and Group 2.

Identifying usual food choices with avocados in a clinical trial cohort of overweight and obese adults in Australia.

Consumption of avocados has been suggested to be beneficial for weight control, however, limited research is available about the related food choices. Understanding the food choices associated with avocados at meal occasions may further aid behavioural strategies to lose weight. The present study used a systematic approach to develop an avocado-specific food database, with the aim to explore food choices related to avocados at meal occasions as reported by overweight and obese volunteers in weight loss clinical trials. The avocado-specific database was based on AUSNUT 2011-13 food composition database structure and was developed via a systematic approach, which determined the avocado content of Australian foods and beverages. Baseline usual food intake data was retrospectively pooled from four food-based clinical trials (n = 758). The Apriori algorithm of association rules, a two-step descriptive method was used to identify food choices associated with avocados at different meal occasions using a nested hierarchical food group classification system. The avocado database identified 34 avocados and avocado-containing foods and beverages. The proportion of avocado consumers in the pooled cohort was 51.3% (n = 389), with an average avocado intake of 21.57 ± 36.75 grams per day. Avocados were found to be closely related to other food groups at all of the food group levels at main meal occasions. A total of 68 food items containing avocados were identified for avocado consumers at the breakfast, lunch and dinner meals. The avocado specific database provides a snapshot of the foods and beverages which contain avocados. Enumerating the full range of food choices in relation to avocado consumption should provide examples of food choices that people might consider in their efforts to increase their avocado consumption.

Predicting outcomes in female germ cell tumors using a modified International Germ Cell Cancer Collaborative Group classification system to guide management

ObjectiveWe previously developed preoperative and pre-chemotherapy modified versions of the male International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic model and assessed it in female patients with germ cell tumors (GCTs). We sought to validate these modified IGCCCG (mIGCCCG) models in a new cohort. MethodsWe queried institutional databases for female patients with GCTs treated at Memorial Sloan Kettering Cancer Center from 1/1/1990–6/1/2020. The mIGCCCG model classifies patients with non-dysgerminomas as good, intermediate, or poor risk based on tumor markers using male IGCCCG cutoffs and absence/presence of non-pulmonary/peritoneal visceral metastasis. In dysgerminomas, good- and intermediate-risk groups are defined by absence/presence of non-pulmonary/peritoneal visceral metastasis. Progression-free survival (PFS) and overall survival (OS) were estimated for each group in the validation and combined original and validation cohorts. Associations between individual clinical factors and outcomes were evaluated. ResultsAmong 183 female patients with GCTs, clinical characteristics and outcomes were similar between the original (n = 93) and validation (n = 90) cohorts. In multivariable models, higher stage, older age, and non-dysgerminoma histology predicted worse PFS and OS (p < 0.05). Among 162 patients who received chemotherapy, preoperative and pre-chemotherapy mIGCCCG models were significantly associated with PFS and OS (p < 0.001 for all groups). With the preoperative model, 3-year PFS rates were 94%, 76%, and 50% in the good-, intermediate-, and poor-risk patients, respectively; OS rates were 96%, 86%, and 52%, respectively. Even within stage groups, mIGCCCG risk classifications were associated with clinical outcomes. ConclusionsA female-specific mIGCCCG risk model effectively stratifies patients and should be incorporated into clinical trials.

An Evaluation of Cesarean Delivery Rates According to Robson Classification in the Black Sea Region of Turkey

To analyse cesarean deliveries (CD) using the Ten Group Classification System (TGCS) for reducing cesarean rates. Cross-sectional study. Ordu University Medical Faculty Training and Research Hospital, Ordu, Turkey, from 1st January 2008 to 31st December 2020. A total of 29,885 deliveries during the 13-year study period were analysed. Group sizes and annual, overall, absolute, and relative CD rates were calculated to analyse the effect of the Robson groups (RGs)/TGCS. The data were analysed using the two-way Chi-square test and two-proportion Z-test with Bonferroni correction. The overall CD rate was 59.22% (17,697). The principal contributors to the overall CD rate were RG5 (54.48%), RG1 (12.52%), and RG2 (10.06%). The relative CD rate in preterm pregnancies (RG10) increased approximately five-fold over the 13-year study period due to the increase in both group size and absolute CD rate (p<0.001). TGCS shows the cesarean delivery trends in terms of cesarean rates and identifies those groups requiring special precautions. The target groups (RG5, RG1, RG2 and RG10) need more in-depth research to reduce CD rates. Various approaches need to be implemented including individualised cesarean indication, encouragement of vaginal delivery after cesarean delivery, expectant management in nulliparous women, and spontaneous labor for preterms labor. Cesarean section, Elective cesarean section, Induction of labor, Vaginal birth after cesarean section, Robson classification, Preterm deliveries.

Impact of extent of resection on outcome from glioblastoma using the RANO resect group classification system: a retrospective, population-based cohort study.

Extent of resection (EOR) is associated with survival in glioblastoma. A standardized classification for EOR was lacking until a system was recently proposed by the response assessment in neuro-oncology (RANO) resect group. We aimed to assess EOR in an unselected glioblastoma cohort and use this classification system to evaluate the impact on survival in a real-world setting. We retrospectively identified all patients with histologically confirmed glioblastoma in Western Norway between 1.1.2007 and 31.12.2014. Volumetric analyses were performed using a semi-automated method. EOR was categorized according to the recent classification system. Kaplan-Meier method and Cox proportional hazard ratios were applied for survival analyses. Among 235 included patients, biopsy (EOR class 4) was performed in 50 patients (21.3%), submaximal contrast enhancement (CE) resection (EOR class 3) in 66 patients (28.1%), and maximal CE resection (EOR class 2) in 119 patients (50.6%). Median survival was 6.2 months, 9.2 months, and 14.9 months, respectively. Within EOR class 2, 80 patients underwent complete CE resection (EOR class 2A) and had a median survival of 20.0 months, while 39 patients had a near-total CE resection, with ≤1 cm3 CE residual volume (EOR class 2B), and a median survival of 11.1 months, P < 0.001. The 2-year survival rate in EOR class 2A was 40.0%, compared to 7.7% in EOR class 2B. RANO resect group classification for the extent of resection reflected outcome from glioblastoma in a real-world setting. There was significantly superior survival after complete CE resection compared to near-total resection.

Corrigendum to: Impact of extent of resection on outcome from glioblastoma using the RANO resect group classification system: a retrospective, population-based cohort study

Corrigendum to: Impact of extent of resection on outcome from glioblastoma using the RANO resect group classification system: a retrospective, population-based cohort study

Analysis of cesarean section using Robson’s criteria in tertiary care center

Introduction: This study aims to analyze all the women delivering in our institute according to the Robson’s classification. Robson’s ten group classification system (TGCS) endorsed by WHO, is a global standard tool for assessing, monitoring and comparing cesarean section rates at all levels.&#x0D; Method: This cross sectional study was conducted in the department of obstetrics and gynecology, Patan hospital, Patan academy of health sciences (PAHS), Lalitpur, Nepal over 12 months’ period. All women who delivered during this period were classified according to the Robson’s classification (TGCS) into a specific group. Relative size and overall cesarean section rate of each group were calculated.&#x0D; Result: A total of 4,985 cases were analyzed. The cesarean section rate was 57.7%. Group 1+2 represented nearly half (49%) of the obstetric population served during the study period. Group 2A was found to be the highest contributor (27.4%) followed by Group 5 (22.8%) and Group 1 (13.0%). In terms of indication for cesarean section -Fetal distress and previous cesarean section were found to be the most common indications. Similarly, nulliparous women were three to four times more likely to be delivered by cesarean section when labor was induced.&#x0D; Conclusion: From this study, we can conclude that for an effective reduction in the overall high cesarean section rate in our Institution, we need to focus on a more stringent protocol for inducing labor especially among nulliparous women and to practice evidence based guidelines. Redefining failed induction needs to be considered critically as well.

The rate of cesarean delivery changes after internal audit based on the Robson Ten Group Classification System in Lebanon.

To evaluate the efficiency of the Robson classification as an internal clinical audit and feedback of the high rate of cesarean delivery at Hotel Dieu de France, a tertiary referral hospital. A pre-post study was conducted, with a retrospective approach in 2018 and 2019, identified as the pre-period (before the implementation of the Robson classification), and with a prospective approach in 2020 and 2021, labeled the post-period. The total number of deliveries during the study period was 2560; 1305 patients were included in the pre-period and 1255 patients delivered in the post-period. No significant differences between the two groups were found. No significant difference was found in the overall rate of cesarean delivery between the first and second periods (57.86% vs 56.72%; P= 0.2). However, a significant decrease in the absolute contribution of groups 3 and 4 (multiparous women without a previous uterine scar with a single cephalic pregnancy, ≥37 weeks of gestation, with spontaneous labor or induced labor) in the overall rate of cesarean delivery was remarked (P= 0.02 and 0.01, respectively). The Robson classification seems to be appropriate to monitor and audit the rate of cesarean delivery, but not sufficient to decrease the rate and change the practice.

Trends in Caesarean Section Rate According to Robson Group Classification among Pregnant Women with SARS-CoV-2 Infection: A Single-Center Large Cohort Study in Italy.

Since there is no available data on temporal trends of caesarean section (CS) rates in pregnant women with COVID-19 through the pandemic, we aimed to analyze the trends in caesarean section rate in a large cohort of pregnant women with COVID-19, according to the Robson Ten Group Classification System of deliveries. We prospectively enrolled pregnant women with a diagnosis of COVID-19 who delivered in our center between March 2020 and November 2021. Deliveries were classified, according to the Robson group classification, and according to three time periods: (1) deliveries from March 2020 to December 2020; (2) deliveries from January 2021 to April 2021; (3) deliveries from May 2021 to November 2021. We compared pregnancy characteristics and incidence of caesarean section, according to the Robson category in the total population, and according to the three time periods. We included 457 patients matching the inclusion criteria in our analysis. We found that overall CS rate significantly decreased over time from period 1 to period 3 (152/222, 68.5% vs. 81/134, 60.4% vs. 58/101, 57.4%, χ2 = 4.261, p = 0.039). CS rate significantly decreased over time in Robson category 1 (48/80, 60% vs. 27/47,57.4% vs. 8/24, 33.3%, χ2 = 4.097, p = 0.043) and Robson category 3 (13/42, 31% vs. 6/33, 18.2% vs. 2/22, 9.1%, χ2 = 4.335, p = 0.037). We also found that the incidence of induction of labor significantly increased over time (8/222, 3.6% vs. 12/134, 9% vs. 11/101, 10.9%, χ2 = 7.245, p = 0.027). Our data provide an overview of the temporal changes in the management and obstetric outcome of COVID-19 pregnant women through the pandemic, confirming that standards of obstetrical assistance for pregnancies complicated by SARS-CoV-2 infection improved over time.

Distribution of ABO and Rhesus Types in the Northern Asir Region in Saudi Arabia.

The ABO blood group system is used to denote the presence of one, both, or neither of the A and B antigens on erythrocytes. In humans, this is the most important of the 43 different blood type (or group) classification systems currently recognized. Distribution of ABO and Rh among the Saudi population could affect many factors such as blood transfusion, prognosis, resistance and susceptibility to diseases. The impetus of this study was to develop an understanding of the distribution of the ABO and Rh types of healthy volunteer blood donors in the northern Asir region of Saudi Arabia, comparing the findings to similar studies. Understanding the frequency of different blood types in different populations is imperative. This study was performed during the period of January 1, 2020, to December 31, 2020, using samples from 4167 voluntary subjects obtained from the blood bank of the King Abdullah Hospital, Bisha. Commercially provided anti-A, anti-B and anti-D antibodies were used for the standard blood grouping procedure. The findings in this study showed that O was the most prominent ABO blood group, whereas AB was the least so. The frequency of the blood type A was the second highest, followed by the blood group B, whereas Rh positivity was more common than Rh negativity. O+ > A+ > B+ > O-> AB+> A-> B- > AB- was found to be the order of blood group frequency in the current study.

Robson Ten Group Classification System and Fetal Distress as the Indication for Caesarean Section

Background: The marked increase in the rates of CS has not only raises the challenges for the medical professional but also became a debatable issues for many gynecologists. In order to explain the increasing rates of CS it is necessary to identify which group of women is more frequently undergoing CS. Objective: The study aimed to evaluate the role the fetal distress and Robson ten group classification play for the indication of caesarean section. Study design: It is a retrospective study conducted at Khawaja Muhammad Safdar Medical College, Allama Iqbal Memorial Teaching Hospital Sialkot, from January 2022 to June 2022. Material and Methods: 5787 women were admitted in tertiary care unit for delivery. Among these 2031 went through caesarean and the remaining delivered normally. Most of the population was included in group 1 and 5, where 501 and 535 individuals were present. Results: The group having the most contribution towards CS was group 5. And the group showing least contribution towards CS was group no.10. Group 5 also showed high contribution towards CS. The evaluation was carried out for 205 patients, the mean age of the patients was 26 years in this study. Most of the patients belonged to gestation week greater than 36 weeks. Conclusion: The group that has low risk had more chances to contribute to the CS rate. The indication for CS was most of the time fetal distress which was seen at the time patients were admitted in hospital. Keywords: Caesarean section and fetal distress.

The Effect of Epidural Analgesia on Labour and Neonatal and Maternal Outcomes in 1, 2a, 3, and 4a Robson's Classes: A Propensity Score-Matched Analysis.

Background: Lumbar epidural analgesia (EA) is the most commonly used method for reducing labour pain, but its impact on the duration of the second stage of labour and on neonatal and maternal outcomes remains a matter of debate. Our aim was to examine whether EA affected the course and the outcomes of labour among patients divided according to the Robson-10 group classification system. Methods: Patients of Robson’s classes 1, 2a, 3, and 4a were divided into either the EA group or the non-epidural analgesia (NEA) group. A propensity score-matching analysis was performed to balance the intergroup differences. The primary goal was to analyse the duration of the second stage of labour. The secondary goals were to evaluate neonatal and maternal outcomes. Results: In total, 21,808 cases were analysed. The second stage of labour for all groups was prolonged using EA (p < 0.05) without statistically significant differences in neonatal outcomes. EA resulted in a lower rate of episiotomies in nulliparous patients, with a higher rate of operative vaginal deliveries (OVD) (p < 0.05) and Caesarean sections (CS) (p < 0.05) in some classes. Conclusions: EA prolonged the duration of labour without affecting neonatal outcomes and reduced the rate of episiotomies, but also increased the rate of OVDs.

Cesarean delivery rates and indications in pregnancies complicated by diabetes

Objective Rates of pregestational (PGDM) and gestational diabetes (GDM), and their associated pregnancy complications, are rising. Pregnancies complicated by diabetes have increased cesarean delivery (CD) rates; however, there are limited data regarding the current rates of, and contributing factors to, these deliveries. The Robson Ten Group Classification System (TGCS) is a clinically relevant, standardized framework that can be used to evaluate and analyze cesarean rates. The objective of this study was to evaluate rates of, and indications for, intrapartum, unplanned CD among pregnancies complicated by diabetes, compared to normoglycemic (NG) pregnancies, in a large United States birth cohort. Methods This retrospective cohort study used chart-abstracted data on births between 24 and 42 weeks’ gestation at 17 hospitals that contributed to the Obstetrical Care Outcome Assessment Program database between 01/2016 and 03/2019. The CD rate for NG pregnancies, and pregnancies complicated by gestational and PGDM was calculated and compared using the Robson TGCS. The indications for intrapartum CD in patients with term, singleton, vertex gestations without a prior cesarean were then analyzed. Univariate and multivariate logistic regression models were used to compare the cesarean rate and indications for CD, between the diabetic groups and the NG group. Results were adjusted for maternal age, BMI, neonatal birth weight, and insurance status, as well as clustering by hospital. Results A total of 86,381 pregnant people were included in the study cohort. Of these 76,272 (88.3%) were NG, 8591 (9.9%) had GDM, and 1518 (1.8%) had PGDM. Compared to NG patients, overall cesarean rates were higher in patients with GDM (40.3% vs. 29.7%; aOR 1.25, 95%CI 1.18–1.31) and PGDM (60.0% vs. 29.7%; aOR 2.53, 95%CI 2.04–3.13). This finding remained true when the cohort was restricted to term, singleton, vertex laboring patients without a prior cesarean; compared to NG patients, the cesarean rate was higher in patients with GDM (17.4% vs. 12.2%, aOR 1.37, 95%CI 1.29–1.45) and PGDM (26.0% vs. 12.2%, aOR 2.55, 95%CI 2.00–3.25). The cesarean rate for fetal indications was similar in the GDM (5.7%) and NG (4.4%) groups, while those patients with PGDM had a significantly higher rate (10.4%; aOR 2.01, 95%CI 1.43–2.83). Similarly, the rate of cesarean for labor dystocia in patients with PGDM was significantly higher than in NG patients (16.9% vs. 7.0%, and aOR 2.28, 95%CI 1.66–3.13) while patients with GDM had an intermediate rate (10.6% vs. 7.0%, aOR 1.49, 95%CI 1.40–1.57). Conclusions The CD rate is significantly higher in pregnancies complicated by diabetes, particularly pregestational, compared to NG pregnancies. Despite controlling for maternal factors and birth weight, pregnancies complicated by diabetes are more likely to undergo an unplanned intrapartum cesarean secondary to labor dystocia than their NG counterparts, but only pregnancies complicated by PGDM have an increased risk of cesarean for fetal indications. More research is needed to understand whether this higher cesarean rate is due to factors intrinsic to diabetes in laboring patients or is due to a difference in the way clinicians manage diabetics in labor.

P011: IPS-7 or IPS-3 to identify very-high risk patients in advanced Classical Hodgkin’s Lymphoma: Which score to choose

Figure 1: PFS and OS for both IPS-3 and IPS-7 scores Introduction: The survival of patients (pts) with classic Hodgkin Lymphoma (cHL) has been significantly increased due to refinement of therapeutic strategies. International Prognostic Score (IPS-7) is the most used risk stratification tool for patients with advanced-stage cHL but it may have decreased prognostic value in cHL pts treated in the contemporary era. A novel scoring system, IPS-3, comprising three of the seven IPS-7 indicators (age ≥45, stage IV, haemoglobin <105 g/L), was recently proposed to identify high-risk patients but require further validation. Aim: To validate IPS-3 and evaluate its discriminatory power in advanced stages cHL. Methods: Single centre retrospective analysis of adult pts with cHL diagnosed between 1990 and 2017 treated with ABVD, ABVD hybrid protocols or escalated BEACOPP. Advanced stage was defined according to the German Hodgkin Study Group classification system. Stratified models for IPS-3 and IPS-7 were compared using Akaike’s information criteria (AIC) and Harrell’s concordance index (C-index). Results: We included 227 pts, with similar gender proportion; median age was 32.3 (18–80). Nodular sclerosis was the most common histologic subtype (n=176 pts; 77.5%); 90 pts (39.6%) presented stage IV; 13 pts (5.7%) had IPS-3 high risk, 12 pts (5.3%) IPS-7 high risk and 8 pts (3.5%) had both. After a median follow-up of 123 months (m), the median overall survival (OS) was not reached. IPS-7 (HR 2.13 [95%IC 1.49–3.05]; p<0.001) and IPS-3 (HR 3.05 [95%IC 1.98–4.69]; p<0.001) identify different prognosis groups for OS, with IPS-3 (AIC 633; C-index 0.6547) providing best fit for data compared with IPS-7 (AIC 643; C-index 0.6403). Median progression free survival (PFS) was 295.6m. IPS-7 (HR 1.43 [95%IC 1.05–1.96]; p=0.025) and IPS-3 (HR 1.72 [95%IC 1.20–2.46]; p=0.003) identified different prognostic groups for PFS, with IPS-3 (AIC 917; C-index 0.5717) providing best fit for data compared with IPS-7 (AIC 921; C-index 0.5570). IPS-3 remained predictive for OS (HR 3.05; p<0.001) and PFS (HR 1.72; p=0.003) after adjustment for treatment protocol and had a good performance discriminating high vs intermediate/low risk for OS and PFS (HR 2.40; p=0.002 and PFS HR 3.03; p=0.001, respectively). Conclusion: IPS-3 had better performance predicting OS and PFS compared with IPS-7, allowing a better segregation of patients with worse prognosis, which suggests its value to identify patients that will benefit more aggressive treatment protocol.