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Am J Perinatol 2024; 41(09): 1223-1231
DOI: 10.1055/s-0042-1748527
Original Article

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

Daniel N. Pasko 
1   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Paula McGee
2   The George Washington University Biostatistics Center, Washington, District of Columbia
,
William A. Grobman
3   Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
,
Jennifer L. Bailit
4   Department of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio
,
Uma M. Reddy
5   The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
,
Ronald J. Wapner
6   Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Michael W. Varner 
7   Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
,
John M. Thorp Jr.
8   Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Steve N. Caritis
9   Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Mona Prasad
10   Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
George R. Saade
11   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Yoram Sorokin
12   Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
,
Dwight J. Rouse
13   Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
,
Jorge E. Tolosa
14   Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
,
for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units (MFMU) Network› Institutsangaben
Funding The project described was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) [HD21410, HD27869, HD27915, HD27917, HD34116, HD34208, HD36801, HD40500, HD40512, HD40544, HD40545, HD40560, HD40485, HD53097, HD53118] and the National Center for Research Resources [UL1 RR024989; 5UL1 RR025764]. Comments and views of the authors do not necessarily represent views of the National Institutes of Health.
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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.

Keywords

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

* See the Supplementary Materials for a list of other members of the NICHD MFMU Network.


Supplementary Material



Publikationsverlauf

Eingereicht: 21. Februar 2022

Angenommen: 14. März 2022

Artikel online veröffentlicht:
03. Juni 2022

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