Robson 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 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).

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.

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..

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 using Robson's ten group classification system in a tertiary care center from Southern India: A cross-sectional study

Background: The rising cesarean section (CS) rate is a global concern and World Health Organization in 2015 has proposed the use of Robson-10 group classification system as a standard for assessing and monitoring CS both within and across the healthcare facilities. Objective: The objective is to analyze the CSs performed in a teaching hospital using Robson 10-group classification system. Methodology: The present cross-sectional study was done over a period of 1 year from May 2017 to April 2018. All eligible women delivered in JIPMER, a tertiary care referral center during the study period were classified as per Robson Ten-Group classification system. Caesarean delivery rates were reported. The relative and absolute contribution to CS rates in each groups were calculated. Epi data V.3.1 was used for data analysis. Results: Among 16,863 women delivered during the study, the CS rate was 21.4%. The three common indications for CS overall were fetal distress, nonprogress of labor, and cephalopelvic disproportion. Group 1 (nulliparous, singleton, term cephalic, spontaneous labor) was the largest size followed by group 2 (nulliparous, singleton, term cephalic, induced labor) with 25% and 16.9%, respectively. The maximum contribution of CS was by group 5 (multiparous women, singleton, term cephalic, previous uterine scar) followed by group 2 with 34.9% and 18.9%, respectively. Conclusion: Robson group 5, 2, and 1 were the major contributions to CS in our hospital. Further studies are needed to study the appropriateness of indications for CS especially in groups 2 and 1 as they are the future group 5.

Using the Robson Classification to Explain the Fluctuations in Cesarean Section.

Purpose As the rate of cesarean sections (CS) continues to rise in Flanders (northern part of Belgium), it is important to understand the reasons behind this evolution and to find ways to achieve appropriate CS rates. For this analysis, we categorized CS changes between 1992 and 2016, applying the Robson 10-Group Classification System (TGCS). We also applied the TGCS to analyze the information of the only clinics where between 2008 and 2016, the absolute CS rate had fallen by more than two percent. Methods This paper is based on a population-based cross-sectional study. Robson's TGCS was used to analyze CS rates for the years 1992, 2000, 2008, and 2016, using the Flemish population-based birth register. Results Between 1992 and 2016, the overall CS rate increased from 11.8% in 1992 to 20.9% in 2016. The major contributors to that increase were (a) single, cephalic nulliparous women, at term in spontaneous labor (Robson group 1); (b) single, cephalic nulliparous women, at term in induced labor or CS before labor (group 2); and (c) multiparous women with single cephalic at term pregnancy with history of CS (group 5). In the subgroup of the seven clinics where the collective CS rate had decreased from 23.2% in 2008 to 19.3% in 2016, the main contributors to this decrease were Robson groups 1 and 2. Conclusions The CS increase in Flanders between 1992 and 2016 is mainly the result of the absolute CS increase in the childbirth of nulliparous women with a single cephalic baby at term in spontaneous or induced labor and in women with a single cephalic presentation at term and a previous CS. Further research in these aforementioned groups is needed to identify the real reasons for the CS increase.

Cesarean delivery: Trend in indications over three decades within a major city hospital network.

The cesarean delivery rate has been increasing globally in recent decades. The reasons for this are complex and subject to ongoing debate. Investigation of the indications for cesarean delivery and how these have changed over an extended period of time could provide insight into the reasons for changing obstetric practice. Our objective was to explore contributing factors to the increasing rate of cesarean delivery by examining the incidence of and indications for cesarean delivery over the past three decades at our institutions. We conducted a retrospective observational study of all cesarean deliveries, from 24weeks' gestational age onwards, within an inner-city hospital network in Sydney, Australia, between August 1989 and December 2016. The primary outcome measures were the rates of and indications for emergency and planned cesarean delivery. We also examined our data within the Robson 10-Group Classification system. There were 147722 births over the study period, with 37309 cesarean deliveries for an overall rate of 25.3%. The rate of cesarean delivery increased from 18.7% in 1989-1994 (8.7% emergency, 10% planned) to 30.4% in 2010-2016 (11.4% emergency, 19% planned). Emergency cesarean delivery for slow progress increased from 3.4% to 5.5% of all births (a relative increase of 62%) and other emergency cesareans mainly performed for suspected intrapartum fetal compromise increased from 5.2% to 5.6% (a relative increase of 8%). Previous uterine surgery (predominantly cesarean section) was the largest contributor to the increase in planned procedures from 3.8% to 9.0% of all births, and 29% of all cesarean deliveries. Primary cesarean delivery for planned antenatal fetal indications, previous pregnancy problems, multiple gestation and maternal choice all increased substantially in combined rate from 0.7% to 4.9%. Cesarean rates in Robson groups 6, 7 and 8 (term breech and multiple gestations) increased most over time. The increased rate of cesarean delivery is mainly attributable to a greater number of procedures performed for slow progress in labor, breech presentation or repeat cesarean section.

An analysis of the high cesarean section rates in Turkey by Robson classification

Background Cesarean deliveries outnumbered vaginal deliveries in Turkey. The aim of this study is to analyze the CS rates, sizes of the groups and their contribution to CS in the Robson10-Group Classification to address the main drivers that are associated with an increase in CS rates in Turkey by comparing with the customized benchmark, World Health Organization (WHO) Multi-country Survey Reference (MCS) population. We also evaluate the existence of the Pareto principle that states that for many phenomena, about the 80% of the consequences (increase in CS rate) are produced by 20% of the causes. Methods In Turkey, 1503 facilities (public hospitals: 879, private hospitals: 557, university hospitals: 67) provided delivery services for 1 266 300 women in 2017. The distribution of this number to public, private and university hospitals were 630 688 (49.8%), 565 441 (44.7%) and 70 171 (5.5%), respectively. The Ministry of Health in Turkey has established a registration system to analyze the increase in CS rates. by implementation of the Robson’s classification. We analyzed the electronic records of 887 683 women sent from public: 554 916/630 688 (87.98%), private: 297 724/565 441 (52.65%) and university 35, 043/70.171 (49.93%) hospitals. Results Overall CS rate was 51.2%. CS rates in public, private and university hospitals were 39.7, 70.6 and 70.3%, respectively (p < .0001), depicting significant differences for each sector. CS rates were higher than WHO MCS reference population for all Robson groups. Further evaluation was performed to reveal the rank order of Robson groups affecting on the CS rates. Groups 5, 1, 3, 2, 4 and 10 were the six groups constituting more than 80% of the women in healthcare facilities. Analysis of the data revealed the following conclusions in terms of the size of the group and the contribution of each group to total CS rate: Women in Group 5 played the dominant role with a 25.2% in size of the group and 24.4% contribution to the CS rate. Domino effect of the group 5 with both its size and contribution to CS was prominent. 32.3 percent of the women included in Robson Groups 1 and 2. Though CS rate under 10% was reported to be achievable for Robson Group 1 in the WHO MCS reference population, total CS rate was 19.6% in Turkey. In Robson Group 2, CS rate was reported to be 39.9% in the WHO MCS reference population, while the CS rate was 59.6% in Turkey. The size of Robson groups 3 and 4 included 32.9%. Contribution of both groups to CS rate was 5.6%. CS rates for group 3 and 4 were 11.2 and 36.8%, respectively, whereas those were reported to be 3.0% in Group 3 and 23.7% in Group 4 for the WHO MCS reference population. All singleton pregnancies <37 weeks in Robson group 10 constituted 3.1% of the whole group with a 2.3% contribution to the CS rate. Total CS rate for Robson group 10 was 70.5% in Turkey whereas it was reported to be 25.3% for WHO MCS reference population. Conclusions Robson classification in Pareto diagrams for each sector identified the main contributors to the CS rate as Groups 5, 3, 2, 1, 4 and 10 not only to target groups that may benefit from implementations or interventions but also guide public policies and investments for reducing CS rates in Turkey. Consequences of the commercialization on the health care system is apparent. Policies should be directed at the private sector, where 44.7% of the deliveries occur and where CS indication seems not to be driven by medical reasons completely

Using the Robson 10-Group Classification System to Compare Cesarean Birth Utilization Between US Centers With and Without Midwives.

The Robson 10-group classification system stratifies cesarean birth rates using maternal characteristics. Our aim was to compare cesarean birth utilization in US centers with and without midwifery care using the Robson classification. We used National Institute of Child and Human Development Consortium on Safe Labor data from 2002 to 2008. Births to women in centers with interprofessional care that included midwives (n = 48,857) were compared with births in non-interprofessional centers (n = 47,935). To compare cesarean utilization, births were classified into the Robson categories. Cesarean birth rates within each category and the contribution to the overall rate were calculated. Maternal demographics, labor and birth outcomes, and neonatal outcomes were described. Logistic regression was used to adjust for maternal comorbidities. Women were less likely to have a cesarean birth (26.1% vs 33.5%, P < .001) in centers with interprofessional care. Nulliparous women with singleton, cephalic, term fetuses (category 2) were less likely to have labor induced (11.1% vs 23.4%, P < .001), and women with a prior uterine scar (category 5) had lower cesarean birth rates (73.8% vs 85.1%, P < .001) in centers with midwives. In centers without midwives, nulliparous women with singleton, cephalic, term fetuses with induction of labor (category 2a) were less likely to have a cesarean birth compared with those in interprofessional care centers in unadjusted comparison (30.3% vs 35.8%, P < .001), but this was reversed after adjustment for maternal comorbidities (adjusted odds ratio, 1.21; 95% CI, 1.12-1.32; P < .001). Cesarean birth rates among women at risk for complications (eg, breech) were similar between groups. Interprofessional care teams were associated with lower rates of labor induction and overall cesarean utilization as well as higher rates of vaginal birth after cesarean. There was consistency in cesarean rates among women with higher risk for complications.

Changing rates of the modes of delivery over the decades (1976, 1986, 1996, 2006, and 2016) based on the Robson-10 group classification system in a single tertiary health care center

Aim To identify the underlying factors that may affect the changing rates of modes of delivery over the decades based on Robson-10 group classification system (TGCS) in a single tertiary health care center. Materials and methods This study included data from 10,458 deliveries in 1976, 1986, 1996, 2006, and 2016 with fetuses more than or equal to 500 g at the Department of Obstetrics and Gynecology at Hacettepe University Hospital. Patient characteristics and the mode of delivery were evaluated according to the TGCS. Results The cesarean section (CS) rates were 11.4% (304/2668), 19.2% (459/2393), 44.7% (783/1751), 69.3% (1213/1751), and 77.9% (1477/1895) in 1976, 1986, 1996, 2006, and 2016, respectively. CS has become the preferred method of delivery for multiple pregnancies and breech presentations over the years. TGCS Group 5 was the greatest contributor to increased CS ratios. Relative contributions of TGCS Groups 1 and 3 were decreased and relative contributions of Groups 2 and 4 were increased. Operative vaginal deliveries decreased over the years. Conclusion In conclusion, effective management of labor induction, choosing vaginal delivery for appropriate breech presentations and multifetal pregnancies, proper education of obstetricians for operative vaginal delivery and objective evaluation of labor dystocia might be key points in CS rate debates.

Maternal and fetal outcomes following delivery in a tertiary hospital in Johannesburg, South Africa

Background. Caesarean section (CS) rates are rising worldwide. There is growing concern regarding the possible negative impacts on maternal and fetal health. Objective. To assess birth outcomes of CS v. normal vaginal deliveries (NVD) using the Robson 10-group classification system at a tertiary hospital in Gauteng Province, South Africa. Primary postpartum haemorrhage (PPH), neonatal Apgar scores, neonatal intensive care unit admissions and perinatal deaths were recorded. Methods. A retrospective review of all deliveries for neonates ≥500 g during September and October 2016 was undertaken. A total of 1 443 deliveries were assessed. The data were analysed using Statistical Package for the Social Sciences version 23. Results. There were 730 (50.6%) CSs and 713 (49.4%) NVDs. The greatest contributor to the CS rate was group 5 (15.8%). PPH occurred in 8.3% of women delivered by CS, with an odds ratio (OR) of 1.86 (95% confidence interval (CI) 1.194 - 2.900). Additionally, three hysterectomies were performed in the CS group. A significant difference in Apgar scores was found only at 1 minute, with higher scores in the NVD group (CS mean (standard deviation) 7.74 (2.25), and NVD 8.10 (2.11); p =0.002). Eighty-nine (11.6%) neonates delivered by CS required high care admission, with an OR 1.865 (95% CI 1.292 - 2.692) for neonates delivered by CS. Conclusion. The CS rate was 50.6%. Performing a CS should be weighed against the risks of the procedure. Although an understanding of some influences on the rate can be obtained, further research into indications, and protocol generation to optimise this rate, are needed to limit maternal and neonatal birth complications.

Spatial distribution of Robson 10-group classification system and poverty in southern and southeastern Brazil.

To assess the spatial distribution of the Robson 10-group classification system (TGCS) and poverty in southeastern and southern regions of Brazil in 2016. An ecologic study based on public data from the Brazilian Information System on Live Births and the Brazilian Institute of Geography and Statistics, including 1519289 (53.2%) of all live-born neonates in Brazil between January and December 2016. Statistical analysis used Bayesian modelling with spatial distribution following an autoregressive conditional structure, and Moran index. In 2016, the percentage of live-born neonates delivered by cesarean was 58.8% and 60.7% in the southeastern and southern regions, respectively. Robson groups 1 and 3, involving spontaneous labor, were related to regions with higher poverty (Moran index, 0.36 and 0.44, respectively), whereas groups 2 and 5, involving cesarean delivery, were related to poorer regions (Moran index, 0.56 and 0.45, respectively). The frequencies of each group of the Robson TGCS were heterogeneously distributed in the geographic space owing to important associations with the proportion of poverty in the different regions. Actions are needed to develop the poorest regions in order to minimize existing disparities.

The Robson 10‐group classification in Iceland: Obstetric interventions and outcomes

Rising cesarean rates call for studies on which subgroups of women contribute to the rising rates, both in countries with high and low rates. This study investigated the cesarean rates and contributing groups in Iceland using the Robson 10-group classification system. This study included all births in Iceland from 1997 to 2015, identified from the Icelandic Medical Birth Registry (81839). The Robson distribution, cesarean rate, and contribution of each Robson group were analyzed for each year, and the distribution of other outcomes was calculated for each Robson group. The overall cesarean rate in the population was 16.4%. Robson groups 1 (28.7%) and 3 (38.0%) (spontaneous term births) were the largest groups, and groups 2b (0.4%) and 4b (0.7%) (prelabor cesareans) were small. The cesarean rate in group 5 (prior cesarean) was 55.5%. Group 5 was the largest contributing group to the overall cesarean rate (31.2%), followed by groups 1 (17.1%) and 2a (11.0%). The size of groups 2a (RR1.04 [95% CI1.01-1.08]) and 4a (RR1.04 [95% CI1.01-1.07]) (induced labors) increased over time, whereas their cesarean rates were stable (group 2a: P=0.08) or decreased (group 4a: RR0.95 [95% CI0.91-0.98]). In comparison with countries with high cesarean rates, the prelabor cesarean groups (singleton term pregnancies) in Iceland were small, and in women with a previous cesarean, the cesarean rate was low. The size of the labor induction group increased, yet the cesarean rate in this group did not increase.

383. Obese primiparous women undergoing induction of labour have a higher caesarean section rate: An analysis using the Robson 10-group classification system

Obesity in pregnant women is rising rapidly, and is associated with increased rates both elective and emergency caesarean sections, the most frequently performed sugical procedure globally, and this has implications on short and long term maternal and perinatal health. To evaluate the effect of maternal obesity on CS rates and identify the key patient categories according to the Robson Ten-Group Classification System (TGCS) contributing to the high CS rates. Retrospective analysis of obese gravidas (BMI > 30 kg/m2) who delivered in our unit from 1 January 2010 to 31 December 2017. Parameters of parity, number of fetuses, fetal presentation, gestational age, type of onset of labour and mode of delivery were collected to form the 10 patient groups. Non-obese gravidas who delivered during the same period were controls. There were 6115 deliveries, with 740 (12.1%) obese. Overall CS rate in the obese group was 42%, compared to 32% in the control group (P < 0.05). The largest contributor to the overall CS rate was Group 5 (term multiparous singelton pregnancies with at least a previous uterine scar). Among the obese with unscarred uteri, Group 2a (term nulliparous singleton cephalic, induced labour) and Group 10 (all singleton women with preterm deliveries) were the top contributors to the overall CS rate. Induced obese primigravida had a higher CS rate (43.5%) compared to induced obese multigravidas (6.9%) (p < 0.05). Maternal obesity is a significant risk factor for CS, with almost 1 in two obese women having a CS. Parity has an important influence on the success of induction of labour in obesity, with primparity conferring a 6-fold increased risk for CS. The high contribution of pretem CS delivery reflects the association of maternal obesity with high risk obstetric complications such as pre-eclampsia, gestational diabetes and fetal growth disorders.

Cesarean delivery in the United States 2005 through 2014: a population-based analysis using the Robson 10-Group Classification System

Cesarean delivery has increased steadily in the United States over recent decades with significant downstream health consequences. The World Health Organization has endorsed the Robson 10-Group Classification System as a global standard to facilitate analysis and comparison of cesarean delivery rates. Our objective was to apply the Robson 10-Group Classification System to a nationwide cohort in the United States over a 10-year period. This population-based analysis applied the Robson10-Group Classification System to all births in the United States from 2005 through 2014, recorded in the 2003 revised birth certificate format. Over the study 10-year period, 27,044,217 deliveries met inclusion criteria. Five parameters (parity including previous cesarean, gestational age, labor onset, fetal presentation, and plurality), identifiable on presentation for delivery, were used to classify all women included into 1 of 10 groups. The overall cesarean rate was 31.6%. Group-3 births (singleton, term, cephalic multiparas in spontaneous labor) were most common, while group-5 births (those with a previous cesarean) accounted for the most cesarean deliveries increasing from 27% of all cesareans in 2005 through 2006 to >34% in 2013 through 2014. Breech pregnancies (groups 6 and 7) had cesarean rates >90%. Primiparous and multiparous women who had a prelabor cesarean (groups 2b and 4b) accounted for over one quarter of all cesarean deliveries. Women with a previous cesarean delivery represent an increasing proportion of cesarean deliveries. Use of the Robson criteria allows standardized comparisons of data and identifies clinical scenarios driving changes in cesarean rates. Hospitals and health organizations can use the Robson 10-Group Classification System to evaluate quality and processes associated with cesarean delivery.