260781 Using a modified Robson Classification to examine increases in cesarean delivery rates, California, 1996-2005

Monday, October 29, 2012 : 4:50 PM - 5:10 PM

Andrea MacKay, MSPH , Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
Laura Murianni, PhD, MD , Catholic University of Sacred Heart, Insitute of Hygiene, Preventive Medicine and Public Health, Rome 00168, Italy
Claudia Steiner, MD, MPH , Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality (AHRQ), Rockville, MD
Jun (Jim) Zhang, PhD, MD , MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Susan Meikle, MD, MSPH , National Institute of Child Health and Human Development, National Institutesof Health, Bethesda, MD
OBJECTIVES: To use a modified 8-group Robson Classification system to classify clinical and demographic characteristics associated with delivery; to assess the contributions of each class to cesarean rates; and to examine cesarean trends within the classes, overall and by age. The modified Robson system uses clinical parameters to classify deliveries into clinically relevant groups based on three obstetric concepts: category of pregnancy, parity, and gestational age. METHODS: Information from the California 1996-2005 linked birth certificate/hospital discharge records was used to ascertain mode of delivery, parity, previous cesarean, singleton or multiple, fetal presentation, and gestational and maternal age. Deliveries were assigned to classes within the 8-group framework and were stratified by mode of delivery and age. Cesarean rates were calculated per 100 deliveries. Overall and class-specific trends and the relative contribution of deliveries in each class to the overall cesarean rate were analyzed. RESULTS: In 1996-2005, there were over 5 million births in California; the cesarean rate increased 45% between 1996 and 2005 (from 20.9/100 to 30.4/100). About ¾ of all deliveries were assigned to two classes: single, cephalic, term deliveries among 1) nulliparous and 2) multiparous women without prior cesareans; 12-14% of deliveries were single, cephalic, term, repeat cesareans. However, repeat cesareans accounted for 40% of all cesareans and nulliparous single cephalic term cesareans accounted for 30%. Cesarean rates increased with increasing age. CONCLUSIONS: Ongoing efforts to reduce cesarean rates could make the greatest impact by targeting women with previous cesareans and nulliparous women with single, cephalic, term deliveries.

Learning Areas:
Clinical medicine applied in public health
Public health or related research

Learning Objectives:
1. Describe the modified Robson Classification of Cesarean Delivery. 2. Compare cesarean delivery rates and the contribution to the overal cesarean rate in California, by the modified Robson classes. 3. Discuss the age differences in cesarean delivery rates by modified Robson class. 4. Explain how the classification system can inform clinicians in order to target potential reductions in cesaraean delivery rates. 5. Identify the limitations in using administrative data to classify clinical events.

Keywords: Maternal Care, Data/Surveillance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have 15 years experience as a CDC epidemiologist researching maternal morbidity and mortality. I have published 13 articles in peer-reviewed journals and have given presentations/posters on maternal health at ACOG, SPER, MCHEpi, and APHA numerous times.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.