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

Daniel N. Pasko, Paula McGee, William A. Grobman, Jennifer L. Bailit, Uma M. Reddy, Ronald J. Wapner, Michael W. Varner, John M. Thorp, Steve N. Caritis, Mona Prasad, George R. Saade, Yoram Sorokin, Dwight J. Rouse, Jorge E. Tolosa

Research output: Contribution to journalArticlepeer-review

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 We report on the cesarean delivery frequencies in a multicenter U.S. cohort. NTSV gestations (groups 1 and 2) are a primary driver of cesarean deliveries. Patient characteristics contributed most to hospital variation in cesarean deliveries in group 2.

Original languageEnglish (US)
Pages (from-to)1223-1231
Number of pages9
JournalAmerican Journal of Perinatology
Volume41
Issue number9
DOIs
StatePublished - Jun 18 2024
Externally publishedYes

Keywords

  • 10-Group Classification System
  • Robson
  • cesarean delivery
  • nulliparous term singletons in vertex

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

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