The use of the Robson Ten Groups to allow accurate comparison

of caesarean section rates specific to Gestational Diabetes

Mellitus: important implications to clinical practice and patient
counseling
W Courtney, C Carroll, D Courtney, M Higgins, M Robson, F McAuliffe, M Foley

Figure 3 - Caesarean section rates in general population and in women with GDM as per Robson groups
Introduction

This study aimed to investigate the

rate of caesarean section (CS) in
gestational diabetes mellitus (GDM), as
classified by the Robson Criteria (1), a
commonly used method of analysis. Overall GDM CS Rate (%)
Overall CS Rate (%)
Methods

We designed a prospective study of

all women with GDM in a large
tertiary level unit. Cases were
classified into their relevant Robson
group and compared based on the
rate of caesarean section (CS).
Figure 3 demonstrates the Robson Ten Group The majority of women with GDM, who had
Caesarean Section delivery rates in the general had a previous CS, delivered by repeat CS
population vs. those who underwent caesarean (71%).
Results section with GDM.
This is further broken down in Table 1. Figure 4 – Nulliparous women undergoing
In a 7 year period, between 1 January induction with and without GDM
2005 and 31 December 2011, 61,116
women delivered infants at greater Table 1: Robson Ten Group Caesarean Section Delivery rates
80
in Diet controlled GDM vs. Insulin Controlled GDM vs. General
than 24 weeks gestation in this unit; of
Population 60
these 1126 (1.8%) were diagnosed with With GDM
gestational diabetes (Figure 1). 40
20 Without
Figure 1 – Percentage of women with and GDM
without GDM 0
Women Robson 2a Robson 4a
without GDM
(98.2%)
Women with
Conclusion
GDM (1.8%)
The incidence of GDM in this hospital
population remains low.
Women with a diagnosis of GDM had a
65% increased rate of delivery by
caesarean section compared to the
general population. The highest rate of
During this time the overall hospital CS was amongst women with a previous
CS rate was 19.6%, compared to a CS or those undergoing induction of
32.5% rate in women with GDM. labour. Multiparous women undergoing
(Figure 2) induction (group 4a) had a three to four
fold increased rate of delivery by CS
Figure 2 compared to the general population.
This data supports a policy of thoughtful
100% induction of labour in women with GDM
90%
80% and realistic counselling of women
70% regarding the possible outcomes of
60% induction of labour.
50%
40% Normal
30%
20% births (%)
10% References
0% Caesarean
sections (%) Nulliparous women, undergoing induction of
labour (Groups 2a and 4a), had an increased CS 1. Robson MS. Can we reduce the
delivery rate (63% in nulliparous women vs. 20% in caesarean section rate? Best practice &
multiparous women). (See Figure 4.) research Clinical obstetrics &
gynaecology. 2001;15(1):179-94.