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

Hehir, Mark P.; Ananth, Cande V.; Siddiq, Zainab; Flood, Karen; D’Alton, Mary E.

doi:10.1016/j.ajog.2018.04.012

Cited by 105 publications

(113 citation statements)

References 22 publications

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“…Lastly, groups 8 (multiple pregnancies) and 10 (premature births) have an expected contribution of the general CS rate similar to that reported by Robson and other authors [4,11,23,31,33,34].…”

Section: Discussionsupporting

confidence: 87%

Analysis of Caesarean Section Rates Using the Robson Classification System at a University Hospital in Spain

Vila‐Candel

Martín

Escuriet

et al. 2020

IJERPH

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Background: The WHO recommends the use of the Robson ten-group classification system (RTGCS) as an effective monitoring and analysis tool to assess the use of caesarean sections (CS). The present study aimed to conduct an analysis of births using the RTGCS in La Ribera University Hospital over nine years and to assess the levels and trends of CS births. Methods: Retrospective study between January 1, 2010, and December 31, 2018. All eligible women were allocated in RTGCS to determine the absolute and relative contribution made by each group to the overall CS rate; linear regression and weighted least squares regression analysis were used to analyze trends over time. The risk of CS of women with induced versus spontaneous onset of labor was calculated with an odds ratio (OR) with a 95% CI. Results: 16,506 women gave birth during the study period, 19% of them by CS. Overall, 20.4% of women were in group 1 (nulliparous, singleton cephalic, term, spontaneous labor), 29.4% in group 2 (nulliparous, singleton cephalic, term, induced labor or caesarean before labor), and 12.8% in group 4 (multiparous, singleton cephalic, term, induced or caesarean delivery before labor) made the most significant contributions to the overall rate of CS; Conclusions: In our study, Robson Groups 1, 2, and 4, were identified as the main contributors to the hospital's overall CS rate. The RTGCS provides an easy way of collecting information about the CS rate, is a valuable clinical method that allows standardized comparison of data, and time point, and identifies the groups driving changes in CS rates. justification do not reduce maternal or infant death rates if carried out at a rate higher than 10%-15% [2]. The unjustified, excessive use of clinical procedures can lead to an ever-increasing therapeutic cascade of avoidable interventions [3] and become life-threatening in the present or future pregnancies for both the women and children [4]. The worldwide rise in CS rates has become a growing public health concern and a cause for debate due to potential maternal and perinatal risks, cost issues, and inequity in access [5].There is a high degree of variability in the reported crude rates of CS performed in different countries and regions, and there are often even significant differences between hospitals within a single region. The highest caesarean rates are observed in the Dominican Republic (56.4%), Brazil (55.6%), and Egypt (51.8%), with Africa (7.3%) showing the lowest proportion of these procedures [1]. In most European countries, the rates are about 25% to 35% [5]. In Spain, the average CS rate reported across the 17 autonomous communities, the governing entities independently responsible for health care [6] and for deploying health resources to serve the needs of their local populations, was found to be 24.5% in 2015 [7,8]. However, due to the decentralized structure of the health system, there is no nationally established system to monitor the use of caesarean procedures.Achieving reductions in maternal and infant morbidity and morta...

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Section: Discussionsupporting

confidence: 87%

Analysis of Caesarean Section Rates Using the Robson Classification System at a University Hospital in Spain

Vila‐Candel

Martín

Escuriet

et al. 2020

IJERPH

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“…Consequently, pre‐labour caesarean cases may have been overestimated. As we combined pre‐labour caesareans and induced labour cases, the rates of caesareans in our Robson groups 2 and 4 would have been overestimated, and the rates are not comparable to the study that re‐classified groups 2 and 4 based on pre‐labour caesarean and induced labour . Additionally, women with previous caesareans in our dataset do not reflect all previous caesareans that occurred in the USA because if women with previous caesareans had not delivered their another live‐born infant during the study period, they would not be included in this dataset; thus, underestimating the previous caesarean rate.…”

Section: Commentmentioning

confidence: 91%

“…As we combined pre-labour caesareans and induced labour cases, the rates of caesareans in our Robson groups 2 and 4 would have been overestimated, and the rates are not comparable to the study that re-classified groups 2 and 4 based on pre-labour caesarean and induced labour. 35 Additionally, women with previous caesareans in our dataset do not reflect all previous caesareans that occurred in the USA because if women with previous caesareans had not delivered their another live-born infant during the study period, they would not be included in this dataset; thus, underestimating the previous caesarean rate. Woman's geographical residence factors (types and number of hospitals, density and types of health care providers) may partly explain the observed socio-economic variation in caesarean; 15,17,36 however, this study was unable to analyse this due to unavailability of data.…”

Section: Limitations Of the Studymentioning

confidence: 99%

Differences in caesarean rates across women's socio‐economic status by diverse obstetric indications: Cross‐sectional study

Adhikari

McNeil

McDonald

et al. 2018

Paediatric Perinatal Epid

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“…Future research into the drivers of CD disparities among border Hispanics will have to include state of residence and other contextual factors. Future research might also employ a more detailed, non-overlapping classification of CDs [31] to shed further light on the discrepancies in CD rates shown here. Reducing border CD rates will require additional interventions that address the causal factors operating in this region.…”

Section: Discussionmentioning

confidence: 99%

Trends in Hispanic and non-Hispanic white cesarean delivery rates on the US-Mexico border, 2000-2015

McDonald¹,

Amatya²,

Gard³

et al. 2018

PLoS ONE

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BackgroundCesarean delivery occurs in one in three US births and poses risks for mothers and infants. Hispanic cesarean rates were higher than non-Hispanic white rates in the US in 2016. In 2009, cesarean rates among Hispanics on the US-Mexico border exceeded rates among US Hispanics. Since 2009, rates have declined nationwide, but border Hispanic rates have not been studied.ObjectiveTo compare cesarean delivery rates and trends in Hispanics and non-Hispanic whites in border and nonborder counties of the four US border states before and after 2009.Study DesignWe used data from birth certificates to calculate percentages of cesarean deliveries among all births and births to low-risk nulliparous women during 2000–2015, and among births to low-risk women with and without a previous cesarean during 2009–2015. We calculated 95% confidence intervals around rates and used regular and piecewise linear regression to estimate trends for four ethnic-geographic subpopulations defined by combinations of Hispanic ethnicity and border-nonborder status.ResultsOf the four subpopulations, border Hispanic rates were highest every year for all cesarean outcomes. In 2015 they were 38.3% overall, 31.4% among low-risk nulliparous women, and 21.1% and 94.6% among low-risk women without and with a previous cesarean, respectively. Nonborder Hispanic rates in 2015 were lowest for all outcomes but repeat cesarean. Rates for all four subpopulations rose steadily during 2000–2009. Unlike rates for non-Hispanic whites, border and nonborder Hispanic rates did not decline post-2009. Most of the border Hispanic excess can be attributed to higher cesarean rates in Texas.DiscussionBorder Hispanic cesarean rates remain higher than those among other Hispanics and non-Hispanic whites in border states and show no signs of declining. This continuing disparity warrants further analysis using individual as well as hospital, environmental and other contextual factors to help target prevention measures.

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

Cited by 105 publications

References 22 publications

Analysis of Caesarean Section Rates Using the Robson Classification System at a University Hospital in Spain

Analysis of Caesarean Section Rates Using the Robson Classification System at a University Hospital in Spain

Differences in caesarean rates across women's socio‐economic status by diverse obstetric indications: Cross‐sectional study

Trends in Hispanic and non-Hispanic white cesarean delivery rates on the US-Mexico border, 2000-2015

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