Robson Ten-Group Classification System Research Articles

Profiling births via Caesarean delivery in Northern Ireland (2011-2019) using the Robson classification: a population-based cohort study using administrative maternity system data.

Objective and ApproachCaesarean delivery (CD) rates are increasing globally. Over one-third of babies born in Northern Ireland (NI) during 2021-22 were via CD. Reducing the CD rate was cited as an important public health priority in the Strategy for Maternity Care in Northern Ireland (2012-2018). In 2015, WHO advocated that the Robson Ten Group Classification System (TGCS) be used to audit, analyse, and compare CD rates across countries. TGCS is currently not implemented in NI. ResultsAnalysis of NI’s administrative maternity system (NIMATS) is on-going (accessed via Honest Broker Service Project P045) to address this study’s objectives, which will be completed for presentation: (1) describe the characteristics (maternal, obstetric practice, and fetal/infant features) of all deliveries during 2011-2019; (2) group all births over this period into TGCS categories and calculate the relative size of each group and the absolute contribution of each group to the overall CD rate; (3) compare the NI population distribution of TGCS group-specific CD rates against WHO-recommended benchmarks; (4) test for temporal trends in CD rates here over time; and (5) estimate the ability of a range of maternal, infant, and obstetric factors in predicting the overall CD rate and by TGCS group in NI over time. ConclusionsApplication of the Robson TGCS to NIMATS data has potential to address a critical knowledge gap relating to the use of CD in NI. ImplicationsAvenues to extend this work to investigate longer-term outcomes (via possible linkage to the NI Child Health System) will be considered.

Associations between fetal position at delivery and duration of active phase of labor: A historical cohort study.

In clinical experience, occiput posterior (OP) position is associated with longer labor duration than occiput anterior (OA) position, but few studies have investigated the association between labor duration and fetal position. We aimed to compare duration of the active phase of labor in OP deliveries with OA deliveries in a contemporary population using survival methods. Secondary aims were to compare the frequencies of operative interventions, obstetric anal sphincter injuries (OASIS), postpartum hemorrhage, and newborn outcomes in OP with OA deliveries. We did a historical cohort study in three university hospitals in Norway from 2012 to 2022. Women with a single fetus in cephalic presentation, no previous cesarean section and gestational age ≥37 weeks were eligible and stratified into the first four groups of the Robson ten-group classification system (TGCS). We estimated the mean duration and calculated the hazard ratio (HR) for delivery using survival analyses. Cesarean sections and instrumental vaginal deliveries were censored. The study population comprised 112 019 women, 105 571 (94.2%) were delivered in OA and 6448 (5.8%) in OP position. The estimated mean duration of the active phase of labor was longer in women with the fetus in OP position in all four TGCS groups. The estimated duration was longer in the OP groups in analyses stratified with respect to epidural analgesia and oxytocin augmentation. The graphical abstract illustrates the probability of delivery in OP compared with OA position in merged TGCS groups 1 and 2a, as a function of time. The unadjusted HR was 0.33 (95% CI 0.31-0.36) for fetuses delivered in OP position compared with OA position in TGCS group 1, 0.25 (95% CI 0.21-0.27) in group 2a, 0.70 (95% CI 0.67-0.73) in group 3, and 0.61 (95% CI 0.55-0.67) in group 4a, respectively. Neither maternal age, gestational age, BMI nor birthweight had confounding effect. Operative delivery rates and OASIS rates were higher in OP position in all four groups. We found longer duration of the active phase of labor in women with the fetus delivered in OP position in all four TGCS groups.

Programmed intermittent epidural bolus regimen vs continuous epidural infusion: a retrospective study of motor block and obstetric outcomes using the Robson’s Ten Group Classification System

BackgroundUse of a programmed intermittent epidural bolus (PIEB) regimen during labour is associated with several benefits over a continuous epidural infusion (CEI), including reduced local anaesthetic consumption and reduced risk of motor block. We hypothesise that the benefits of a PIEB regimen may vary according to the Robson Ten Group Classification System (TGCS). The aim of this study was to determine if introduction of a PIEB regimen was associated with reduced incidence of motor block. We also wished to examine changes in obstetric outcomes following PIEB introduction across the Robson TGCS. MethodsThis was a single-centre retrospective cohort study. Data were collected over two three-month periods before and after PIEB introduction. The primary outcome was the incidence of motor block. Maternal and obstetric outcomes across Robson Groups 1–4 were analysed. ResultsIntroduction of PIEB was associated with reduced incidence of motor block (28.4% (95% CI 25.7% to 31.3%) vs 22.4%, (95% CI 19.9% to 25.2%), difference 5.9% (95% CI 1.0% to 21.1%), P=0.003), with no association with changes in rates of caesarean section, operative vaginal delivery or other obstetric outcomes. Use of a PIEB regimen was associated with reduced incidence of motor block in Robson Group 4a (20.3% (16.0%, 28.0%) vs 12.0%, (7.6%, 16.4%), difference 9.9% (95% CI −17.4% to −2.4%) P=0.009). There were no significant changes in other outcomes assessed across Robson TGCS. ConclusionIntroduction of PIEB for maintenance of labour analgesia was associated with reduced incidence of motor block in our institution compared with CEI. Presenting results according to Robson’s TGCS in future studies may allow better elucidation of the impact of neuraxial analgesia on maternal and obstetric outcomes.

Stillbirth mortality by Robson ten-group classification system: A cross-sectional registry of 80 663 births from 16 hospital in sub-Saharan Africa.

To assess stillbirth mortality by Robson ten-group classification and the usefulness of this approach for understanding trends. Cross-sectional study. Prospectively collected perinatal e-registry data from 16 hospitals in Benin, Malawi, Tanzania and Uganda. All women aged 13-49 years who gave birth to a live or stillborn baby weighting >1000 g between July 2021 and December 2022. We compared stillbirth risk by Robson ten-group classification, and across countries, and calculated proportional contributions to mortality. Stillbirth mortality, defined as antepartum and intrapartum stillbirths. We included 80 663 babies born to 78 085 women; 3107 were stillborn. Stillbirth mortality by country were: 7.3% (Benin), 1.9% (Malawi), 1.6% (Tanzania) and 4.9% (Uganda). The largest contributor to stillbirths was Robson group 10 (preterm birth, 28.2%) followed by Robson group 3 (multipara with cephalic term singleton in spontaneous labour, 25.0%). The risk of dying was highest in births complicated by malpresentations, such as nullipara breech (11.0%), multipara breech (16.7%) and transverse/oblique lie (17.9%). Our findings indicate that group 10 (preterm birth) and group 3 (multipara with cephalic term singleton in spontaneous labour) each contribute to a quarter of stillbirth mortality. High mortality risk was observed in births complicated by malpresentation, such as transverse lie or breech. The high mortality share of group 3 is unexpected, demanding case-by-case investigation. The high mortality rate observed for Robson groups 6-10 hints for a need to intensify actions to improve labour management, and the categorisation may support the regular review of labour progress.

Analysis of caesarean delivery rates using Robson ten group classification system in North West Amhara referral hospitals, Ethiopia, 2022: A cross-sectional study

IntroductionThe cesarean delivery rate has been consistently rising over time and differs among different hospitals. In order to understand the specific factors contributing to this rapid increase beyond the recommended levels, it is necessary to continuously monitor and evaluate cesarean deliveries using the Robson ten-group classification system. Consequently, the objective of this study was to evaluate the rate of cesarean deliveries within each group by employing the Robson ten-group classification system. MethodA cross-sectional study design was conducted in referral hospitals in the North West Amhara region, involving 721 mothers who gave birth between January and February 2022. Participants were selected using systematic random sampling. Data collection involved an interviewer-administered, pretested, semi-structured questionnaire, as well as a review of medical charts. The women were allocated into one of the ten Robson groups. The proportion of each group, the contribution of each group to the total caesarean delivery rate, and the caesarean delivery rate within each group were all calculated. ResultThe overall caesarean delivery rate was 277 (38.3 %). The primary factors contributing to the overall cesarean delivery rate were found to be group 1 (23.9 %), group 5 (21 %), group 3 (11.6 %), and group 10 (11%). The most common indication for caesarean delivery included an abnormal fetal heart rate pattern, the presence of meconium in the amniotic fluid, a history of previous cesarean delivery, fetal-pelvic disproportion, and breech presentation. ConclusionGroup 1, 5, 3, and 10 emerged as the major contributor to the overall cesarean delivery rate. Interestingly, this study also unveiled a significant prevalence of cesarean delivery among low-risk groups. These specific groups warrant further investigation to identify potential factors that can be modified and implement targeted interventions to decrease the cesarean delivery rate. It is crucial to evaluate existing management protocols in the study area.

Errors in the classification of pregnant women according to Robson ten-group classification system

ObjectivesThe Robson Ten-Group Classification System (TGCS) is widely used as a classification system for perinatal analyses such as Caesarean section (CS) rates. In Germany, standardised data sets on deliveries are classified by quality assurance institutions using the TGCS. This observational study aims to evaluate potential errors in the TCGS classification of deliveries. Study designManual TGCS classification of all 1370 deliveries in an obstetric unit in 2018 and comparison with semi-automatic TGCS classifications of the quality assurance institution. ResultsIn the manual classification, 259 out of 1370 births (18.9 %) were assigned to a different Robson group than in the semi-automatic classification. The proportions of births by Robson group were significantly different in TGCS group 1 (32.2 % vs. 37.6 %, p = 0.0034) and group 2 (18.4 % vs. 14.4 %, p = 0.0053). Concordance between manual and semi-automatic classifications ranged from 59.5 % in group 2 to 100.0 % in groups 6, 7, 8, and 9. The most frequent mismatches were for the parameters “onset of labour” in 184 cases (13.4 %), “parity” in 42 cases (3.1 %) and “previous uterine scars” in 23 cases (1.7 %). In the manual classification, there were significant differences in the CS rate in group 1 (7.9 % vs. 2.5 %, p < 0.0001), group 2 (30.2 % vs. 48.2 %, p < 0.0001), and group 4 (14.1 % vs. 37.4 %, p = 0.0004), compared to the semi-automatic classification. ConclusionsDue to incorrect data entry and unclear definitions of criteria, quality assurance data in obstetric databases may contain a relevant proportion of errors, which could influence statistics with TGCS in context of CS rates in international comparisons.

Using Robson classification to analyze cesarean section and induction rates in relation to changes in the standards of perinatal care in one hospital in Poland.

Poland has one of the highest cesarean birth (CB) rates in Europe. For this study, we used the Robson Ten-Group Classification System (TGCS) to analyze trends in the induction and CB rates in one hospital in Poland over a period of 11 years. We compare these trends with changes in National Legislative and Medical Guidelines introduced during this time that were aimed at lowering rates of unnecessary medical interventions. We conducted a retrospective study including all births after 24 weeks' gestation between 2010 and 2020 from one tertiary hospital (n = 66,716 births). After the deletion of records with missing data, 66,678 births were included in the analysis. All births were classified according to the Robson TGCS. The size, CB rate, and contribution of each group for every year were calculated. Linear regression analyses were used to analyze trends over time. The total CB rate varied from 29.6% to 33.0% during the study period, with a linear increase of 0.045 percentage points annually (R2 = 0.021; F(1) = 0.189; p = 0.674). This study was considerably lower than the total CB rate for Poland, which rose from 33.9% in 2010 to 45.1% in 2020, increasing at a rate of 1.13 percentage points per year (R2 = 0.93; F(1) = 61.88; p < 0.001). Induction rates among both nulliparous (R1 + R2) and multiparous (R3 + R4) women at term also increased. Study groups R5 (previous cesarean birth), R2 (nulliparous in induced or prelabor cesarean delivery), and R1 (nulliparous women at term with single cephalic pregnancy in spontaneous labor) were the highest contributors to the overall CB rate. The greatest decrease in the CB rate was detected in group R5b (more than one previous CB). None of the groups showed statistically significant increases in CB rates over the study period. The CB rate in the hospital where the study was conducted was considerably lower than the total CB rate in Poland. When compared with countries with similar CB rates, group R2b (women with nulliparous, prelabor cesarean birth) in our study was considerably larger. More comparisons across different hospital settings in Poland are needed. However, as hospitals are not encouraged to routinely collect the data needed to construct TGCS, such comparisons are very difficult to conduct.

Trends in caesarean section rates in Europe from 2015-2019 using Robson's Ten-Group Classification System: A Euro-Peristat registry study

Abstract Objective To assess changes in caesarean section (CS) in Europe from 2015-2019 and utilise the Robson Ten Group Classification System (TGCS) to evaluate the contribution of different obstetric populations to overall CS rates and trends Methods This was an observational study utilising routine population birth data from 28 European countries participating in the Euro-Peristat network. We included all births ≥22 weeks gestational age, from 2015 to 2019. A federated model used individual-level data from routine sources in each country formatted to common data model to generate anonymous, aggregate data tables on yearly CS rates and the Robson TGCS classification. We computed the Robson group-specific relative size, CS rate, relative and absolute contribution to overall CS rate Results Among the 28 European countries, CS rates (2015: 16.0-55.9%; 2019: 16.0-52.2%) and trends varied (-3.7-+4.7%; 9 countries decreasing, 7 stable [ ≤ ±0.2], 12 increasing). Using the Robson Classification (17 countries), in most countries, labour induction increased (Groups 2a, 4a), while multiple pregnancies (Group 8) decreased. In countries with decreasing overall CS rates, CS tended to decrease in most Robson groups, while in countries with increasing overall CS rates, CS tended to increase in most Robson groups. In countries with the greatest increase in CS rates (&amp;gt;1%), absolute contributions of Groups 1 (nulliparous term cephalic singletons, spontaneous labour), 2a and 4a, 2b and 4b (prelabour CS), and 10 (preterm cephalic singletons) to overall CS tended to increase. Conclusions Analysis of the Robson Classification shows varying CS trends and rates across Europe. Comparisons between European countries, particularly those with divergent trends, could provide insight into strategies to reduce CS without indication.

Study of Caesarean Section Births in a Tertiary Care Hospital in Mumbai Using Robson Classification System.

Robson ten-group classification system is recommended by WHO (World health organization) as a global standard for assessment and monitoring caesarean section (CS) rates. This classification is simple and robust. It is prospective, easily reproducible and clinically relevant. We conducted a prospective observational study of CS births at a tertiary care institute. Caesarean births in a tertiary care hospital were classified using Robson classification system as recommended by WHO. The study was conducted for period of 6months duration. The ethics committee of the institute approved this study. We enrolled 4771 consecutive women who delivered during this study period. We included patients who had vaginal delivery as well as those who had delivery by CS. Both live births and stillbirths (of at least 500-g birth weight or at least 22weeks gestation (according to WHO recommendations) were included in this study. During this study period, we had 4771 deliveries, out of which 2231 pregnant women (46.76%) were delivered by CS as compared to 2540 vaginal deliveries. Women with previous CS (term with single cephalic pregnancy) were included in Robson group 5. Group 5 had the highest CS rate (13.41%). Robson group 5, 1 and 10 were the largest contributors to the high CS rates at our institute. In our study, 4771 deliveries were conducted during this study period (6months). Out of 4771 deliveries, CS was done in 2231 pregnant women (46.76%). 2540 women had vaginal deliveries. Group 5 (13.41%) which comprised of women with previous CS had the highest CS rate followed by group 1 and group 10. The second largest contribution was from Group 1 with CS rate of 9.01%. Robson Group 1 included nulliparous term women with single cephalic pregnancy in spontaneous labour. Group 10 was the third largest contributor to the overall CS. Group 10 included women who delivered preterm (single cephalic presentation). Group 10 contributed to 8.09% of overall CS rate. We should make every effort to provide CS for women requiring this procedure, rather than work towards achieving a specific rate for CS.

Auditing cesarean section indications in women of Groups 1 to 4 of Robson's Ten-Group Classification System: A descriptive study at a university hospital in Thailand

Aim: To determine the appropriateness of indication for cesarean section in women at term with a single fetus in cephalic presentation without previous CS irrespective of parity and how labor started (Robson's Ten-Group Classification System [RTGCS] groups 1-4). Methods: This was a descriptive study assessing medical records of 311 women in RTGCS groups 1- 4, between 1st January 2020 and 31st December 2020 who underwent a CS in Srinagarind Hospital, a university hospital, Khon Kaen, Thailand. Appropriateness of CS indications was assessed using criteria developed by our institute. Indications were classified into three categories: cephalopelvic disproportion (CPD), fetal indications, and other maternal indications. Results: The overall appropriate rate of CS indications in RTGCS groups 1-4 was 32.5% (95% CI 26.8% – 38.7%). The appropriate rates of CS indications in RTCGS group 1, 2a, 2b, 3, 4a, and 4b were 43.0% (95% CI 35.2% - 51.2%), 10.6% (95% CI 0.0% - 24.9%), 11.7% (95% CI 0.0% - 25.0%), 50.0% (95% CI 32.1% - 68.6%), 0% (95% CI 0.0% - 100%), and 40.0% (95% CI 20.0% - 74.8%) respectively. Conclusion: Low appropriateness in CS indications in RTGCS groups 1-4 leads to high CS rates. Increasing appropriateness of CS indications in this population will reduce unnecessary CS. Interventions focusing on increasing appropriateness in CS indications are urgently required to achieve appropriate use of CS.

Analysis of Cesarean Section Rates in a Public Tertiary Hospital During Teaching and Non-teaching Periods Using the Robson Ten Group Classification System.

The rising cesarean section (CS) rate is a global concern. One of the hospital characteristics that may explain the variation in CS among hospitals is hospital teaching status. This study aims to assess the rate of CS in a tertiary hospital during the teaching and non-teaching periods and to conduct an analysis using the Robson ten-group classification system. This study is a retrospective cohort that assessed pregnant mothers who gave birth at a tertiary hospital in Bandar Abbas. The study population was divided into two groups: those who gave birth during the hospital's teaching period (November 1st, 2019 to October 30th, 2020) and those who gave birth after that (November 1st, 2020 to October 30th, 2021). The primary outcome was the rate of CS according to Robson's classification system. The secondary outcome was the contributions of each group of Robson to the overall CS rate. Data were extracted by trained collectors from the "Iranian Maternal and Neonatal Network (IMaN Net)," a valid national system, using electronic patient records. Of the total number of births (8382), 62.9 % occurred during the teaching period and 37.1 % during the non-teaching period. A 7% increase in CS was observed during the teaching period of the hospital compared to the non-teaching period (p<0.01). CS rate in Robson groups 1,2,4,7, and 10 differs significantly between teaching and non-teaching periods. According to the findings, Groups 5, 10, and 2 were the three most significant contributors to overall CS in our hospital during the study period. The efforts to reduce the overall CS rate should be focused on groups 2,5, and 10 of Robson.

Increased Cesarean Section Rates during the COVID-19 Pandemic: Looking for Reasons through the Robson Ten Group Classification System.

To compare cesarean section (CS) rates according to the Robson Ten Group Classification System (RTGCS) and its indications in pregnant women admitted for childbirth during the first wave of the coronavirus disease 2019 (COVID-19) pandemic with those of the previous year. We conducted a cross-sectional study to compare women admitted for childbirth from April to October 2019 (before the pandemic) and from March to September 2020 (during the pandemic). The CSs and their indications were classified on admission according to the RTGCS, and we also collected data on the route of delivery (vaginal or CS). Both periods were compared using the Chi-squared (χ2) test or the Fisher exact test. In total, 2,493 women were included, 1,291 in the prepandemic and 1,202 in the pandemic period. There was a a significant increase in the CS rate (from 39.66% to 44.01%; p = 0.028), mostly due to maternal request (from 9.58% to 25.38%; p < 0.01). Overall, groups 5 and 2 contributed the most to the CS rates. The rates decreased among group 1 and increased among group 2 during the pandemic, with no changes in group 10. There was an apparent change in the RTGSC comparing both periods, with a significant increase in CS rates, mainly by maternal request, most likely because of changes during the pandemic and uncertainties and fear concerning COVID-19.

Comparing Cesarean Birth Utilization Between US Hospitals: A Demonstration of the Robson Ten-Group Classification System for Use in Quality Improvement and Benchmarking.

The World Health Organization-endorsed Robson Ten-Group Classification System (TGCS) is a standard reporting mechanism for cesarean birth, yet this approach is not widely adopted in the United States. To describe the application and utility of the TGCS to compare hospital-level cesarean births rates, for use in quality improvement and benchmarking. We conducted a descriptive, secondary data analysis of the Consortium on Safe Labor dataset using data from 228 438 women's births, from 2002 to 2008, in 12 sites across the United States. We stratified births into 10 mutually exclusive groups and calculated within-group proportions of group size and cesarean birth rates for between-hospital comparisons of cesarean birth, trial of labor after cesarean (TOLAC), and labor induction utilization. There is variation in use of cesarean birth, labor induction, and TOLAC across the 12 sites. The TGCS provides a method for between-hospital comparisons, particularly for revealing usage patterns of labor induction, TOLAC, and cesarean birth. Adoption of the TGCS in the United States would provide organizations and quality improvement leaders with an effective benchmarking tool to assist in reducing the use of cesarean birth and increasing the support of TOLAC.

Frequency of Caesarean Section Classified by Robson's Ten Group Classification System: A Scoping Review.

The prevalence of caesarean section (CS) is rising rapidly. However, it should be carried out only under valid obstetric indications due to the various complications associated with it. Therefore, to record CS incidences, Robson's Ten Group Classification System (TGCS) was implemented. This review focuses on the prevalence of CS rates found in various studies and identifies the clinically important groups that were most involved in CS deliveries. Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review (PRISMA-ScR) guidelineswere followed in this review. "Caesarean delivery" OR "Robson's Ten Group" OR "Classification System" were keywords used tosearch literature. Twenty-one studieswere included in this review based on eligibilitycriteria. We concluded that group 5 was the major contributing factor for the increase in CS rates followed by group 10, group 4, group 2, and group 1. Previous CS was the most common factor responsible for increasing CS rates. We emphasize that Robson's TGCS is an essential parameter for recording CS ratesand is simple to use for CS rate comparison.

Variables associated with the Robson Ten-Group Classification System in the State of São Paulo, Brazil

This study evaluated the associations between the groups of the Robson Classification System and maternal sociodemographic characteristics among neonates in São Paulo State, Brazil, 2016. The groups 5, 6, 7, 8 and 9 tend to be associated to cesarean delivery and more privileged educational opportunities, while the groups 1, 4 and 3 tend to be associated to vaginal delivery and less privileged educational opportunities. These results reinforce the notion that strategies for reduction of cesarean deliveries should go beyond a biomedical model focused on biological factors, and should also consider the social factors that characterize the living conditions of people.

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.

COVID-19 and Cesarean Section Rates: A Retrospective Observational Study at Our Rural Tertiary Center using Robson's Classification

Objective: This study aimed to evaluate the effect of COVID-19 infection on the rate and indications for cesarean section (CS) according to Robson's Ten-Group Classification system. Methodology: Our study was a 6-month retrospective observational study at the Maternal and Child Health Wing where every antenatal woman who was admitted irrespective of gestational age and whether in labor or not was customarily screened for COVID-19 infection. Based on the mode of delivery, all delivered women were classified into two groups: vaginal or cesarean, and the information was then further classified according to Robson's classification. Data collected were analyzed using Excel sheets, and Chi-square test was applied to evaluate if the difference in CS rates was statistically significant. Results: During COVID months, a total number of confinements were 877, among which the cesarean section were 381, contributing to a rate of 43.4%. The total COVID-19-positive confinements during the same period were 68. Group 2 formed the vast majority of CSs, followed by Group 1 and 5. During the post-COVID months, summation of confinements was 1443, among which the CS were 580, thereby contributing to a rate of 40.1%. In contrast to COVID time, Group 5 formed the greatest chunk contributing to CS rate, followed by Group 2 and 1. There was a statistically significant difference among confinements during COVID and post-COVID period and between CS rates among COVID-19 positive and negative women. Conclusion: During the COVID pandemic, there was a decrease in the number of confinement in our hospital. However, the CS rate increased and according to Robson's classification Group 1 and 2 made greatest contribution to CSs due to changed dynamics.

Time trends in caesarean section rates and associations with perinatal and neonatal health: a population-based cohort study of 1 153 789 births in Norway

ObjectivesTo study caesarean section (CS) rates and associations with perinatal and neonatal health in Norway during 1999–2018.DesignPopulation-based cohort study.SettingMedical Birth Registry of Norway.Participants1 153 789 births and 1 174 066...

Cesarean delivery rates based on time and indication using the Robson Ten-Group Classification System: Assessment at a Turkish tertiary center.

This study aimed to evaluate increasing cesarean delivery (CD) rates, their causes, and changes over the years in a Turkish tertiary center using the Robson Ten-Group Classification System (RTGCS). Data of deliveries involving birth weight of ≥500 g or ≥24 weeks of gestation period from 2013 to 2020 were retrospectively collected and classified from the hospital digital record system using obstetric concepts and parameters described in the RTGCS. The overall CD rate for all births (69051) from 2013 to 2020 was 55.5%. Groups 3, 5, and 1 were the most represented groups (29.1%, 23.9%, and 19.4%, respectively). The major contributors to the overall CD rate were Groups 5, 2, and 10 (23.8%, 9.9%, and 5.6%, respectively). Groups 2 and 4 (nullipara, multipara, single cephalic at term) had high CD rates associated with high rates of pre-labor CD (88.9% and 73.3%, respectively). The CD rate was 99.7% in Group 5, which showed recurrent CD, and 67.2% in Group 10. The overall CD rate was 60.8% in 2020 owing to the significant increase in the contributions by Groups 5, 8, and 10. The most common indication for CD was previous CD (46.1%), fetal distress (13.2%), and cephalopelvic disproportion (CPD) (8%). Groups 1, 2, 5, and 10 were the major contributors to the overall CD rate at this tertiary center. To reduce overall CD rates, policies that reduce primary CD and support vaginal delivery after cesarean section should be established.

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.