Reaching caesarean section rates below 15%: experience of a French tertiary maternity using the Robson classification...

Area of Science:

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

Background:

• Rising Caesarean section (CS) rates globally raise concerns about necessity and optimal thresholds.
• International data suggest CS rates between 10-15% correlate with reduced maternal and neonatal mortality, but higher rates' benefits are debated.
• Understanding CS trends via classifications like Robson Ten Group Classification System (TGCS) is crucial for targeted interventions.

Purpose of the Study:

• To analyze trends in CS delivery rates using the Robson classification.
• To evaluate maternal and perinatal outcomes in relation to CS rates.
• To identify strategies for controlling the increasing CS rates.

Main Methods:

• Retrospective observational study of 19,082 births (≥22 weeks gestation) from 2017-2023 in a French tertiary university hospital.
• Classification of all deliveries using the Robson Ten Group Classification System (TGCS).
• Analysis of CS rates, contribution to overall CS, and adverse maternal/perinatal outcomes per Robson group.

Main Results:

• The mean CS rate over 7 years was 14.4%, with a significant reduction from 15.4% to 13.0% between 2020-2023.
• This reduction was primarily driven by decreased CS rates in Robson group 5 (women in spontaneous labor with a previous CS) and a trend in group 6 (women with a previous CS, not in labor).
• Maternal and perinatal outcomes remained stable, with a significant reduction in neonatal transfers (1.4%) from 2020-2023.

Conclusions:

• Achieving an average CS rate below 15% is feasible in a tertiary care setting without compromising maternal or neonatal safety.
• Targeted interventions focusing on the management of women with a previous CS and breech deliveries are key strategies for controlling CS rates.
• Robson classification provides valuable insights for monitoring and managing CS trends effectively.