Comparison of Cesarean Deliveries in a Multicenter U.S. Cohort Using the 10-Group Classification System-Reference-Cited by-同舟云学术

Comparison of Cesarean Deliveries in a Multicenter U.S. Cohort Using the 10-Group Classification System

Published:2022-06-03 Issue: Volume: Page:
ISSN:0735-1631
Container-title:American Journal of Perinatology
language:en
Short-container-title:Am J Perinatol

Author:

Pasko Daniel N.¹^ORCID,McGee Paula²,Grobman William A.³,Bailit Jennifer L.⁴,Reddy Uma M.⁵,Wapner Ronald J.⁶,Varner Michael W.⁷^ORCID,Thorp John M.⁸,Caritis Steve N.⁹,Prasad Mona¹⁰,Saade George R.¹¹,Sorokin Yoram¹²,Rouse Dwight J.¹³,Tolosa Jorge E.¹⁴,

Affiliation:

1. Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

2. The George Washington University Biostatistics Center, Washington, District of Columbia

3. Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois

4. Department of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio

5. The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland

6. Department of Obstetrics and Gynecology, Columbia University, New York, New York

7. Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah

8. Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

9. Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania

10. Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio

11. Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas

12. Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan

13. Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island

14. Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon

Abstract

Objective 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. Study Design 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. Results 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. Conclusion 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. Key Points

Publisher

Georg Thieme Verlag KG

Subject

Obstetrics and Gynecology,Pediatrics, Perinatology and Child Health

Link

http://www.thieme-connect.de/products/ejournals/pdf/10.1055/s-0042-1748527.pdf

Reference18 articles.

1. Classifications for cesarean section: a systematic review;M R Torloni;PLoS One,2011

2. Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health;J P Souza;BMC Med,2010

3. WHO Statement on caesarean section rates;World Health Organization Human Reproduction Programme, 10 April 2015;Reprod Health Matters,2015

4. Best practice advice on the 10-Group Classification System for cesarean deliveries;FIGO Working Group On Challenges In Care Of Mothers And Infants During Labour And Delivery;Int J Gynaecol Obstet,2016