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

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Public Health

Background:

• Cesarean delivery (CD) rates are rising globally, necessitating standardized analysis.
• The Robson classification system provides a framework for evaluating CD trends and outcomes.
• Understanding contributors to high CD rates is crucial for improving maternal and neonatal care.

Purpose of the Study:

• To identify the primary contributors to the cesarean delivery rate at the Medical University of Vienna over an 11-year period (2003-2013).
• To analyze neonatal outcome parameters within the ten Robson categories.
• To provide data for informed decisions on reducing cesarean delivery rates.

Main Methods:

• Retrospective analysis of singleton and twin pregnancies (gestational age 23-42 weeks).
• Classification of cases into ten Robson categories based on presentation, multiplicity, and prior uterine surgery.
• Analysis of cesarean delivery rates and perinatal outcomes (NICU admission, 5-min Apgar < 7) per Robson class.

Main Results:

• The overall cesarean delivery rate was 44.2%.
• Robson class 5 (previous CD, singletons in transverse/oblique lie, or fetal malpresentation) had the highest CD rate (99.1%).
• Main contributors to the overall CD rate were Robson class 5 (20.6%), class 2 (nulliparous, singletons, cephalic, no scar, 37+ weeks) (17.1%), and class 8 (all preterm breech) (15.0%).
• Significant variations in neonatal outcomes were observed across different Robson classes.

Conclusions:

• Robson classes 5, 2, and 8 were identified as the main drivers of the high cesarean delivery rate.
• Reconsideration of delivery modes in Robson classes 2, 4, 5, and 8 is suggested.
• Reducing cesarean delivery rates requires careful management, individualized risk assessment, and consideration of perinatal outcomes to ensure clinical relevance and benefit.