Use of the Robson classification to understand the increased risk of cesarean section in case of maternal obesity
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(2020) 20:738
RESEARCH ARTICLE
Open Access
Use of the Robson classification to understand the increased risk of cesarean section in case of maternal obesity Simon Crequit1* , Diane Korb1,2, Cécile Morin1, Thomas Schmitz1,2 and Olivier Sibony1
Abstract Background: The aim of this study was to identify characteristics of pregnant women with obesity that contribute to increased cesarean rate. Methods: Retrospective cohort in a single academic institution between 2012 and 2019. Women who delivered during this period were classified according to the Robson classification. Women with normal body mass index (N = 11,797) and with obesity (N = 2991) were compared. The contribution of each Robson group to the overall caesarean rate were compared. Results: The overall cesarean rate was higher for women with (28.1%) than without (14.2%, p < 0.001) obesity. This result came mainly from Robson group 5a (history of one cesarean). After adjustment for medical factors within this group, the association between maternal obesity and cesarean during labor was significant. Conclusions: The higher cesarean rate in women with obesity is explained by Robson group 5a in which obesity is an independent risk factor of in labor cesarean delivery. Keywords: Maternal obesity, Caesarean section, Robson, BMI and cesarean
Background Maternal obesity is a major health issue in most of industrialized countries. The rate of obesity among pregnant women has increased from 9.9 to 11.8% between 2010 [1] and 2016 [2] in France and from 17.6% in 2003 to 24.5% in 2014 in the US [3, 4]. Previous studies on women with obesity have demonstrated increased pregnancy complications such as hypertensive disorders, gestational diabetes, macrosomia and stillbirth [5–7]. Recent data on maternal obesity have demonstrated an increase in cesarean section (CS) and an increasing number of elective cesarean delivery [8–10]. Indeed, the CS rate increase in women with obesity is becoming of * Correspondence: [email protected] 1 Department of Gynecology and Obstetrics, Robert Debré University Hospital, AP-HP, 48 boulevard Sérurier, 75019 Paris, France Full list of author information is available at the end of the article
concern given the frequency of this disorder. Unfortunately, these data are often focusing on a small part of the pregnant population with obesity such as primiparas, women developing gestational diabetes or only focus on complications. Yet, there are no available data on the risk of caesarean delivery in this population aiming at identifying subgroups at high risk of CS in order to implement measures to reduce the CS rate. To address this issue the Robson classification [11] constitutes a useful tool to identify the characteristics of women contributing the most to the CS rate in a given population. The latter divides births into 10 groups based on obstetrical history, onset of labor, fetal presentation, number of neonates, and gestational age. It is a standardized and reproducible framework that classifies women in relevant categories for analysi
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