ACHIEVING CAESAREAN SECTION RATES BELOW 15%: LESSONS FROM AN OBSERVATIONAL STUDY USING THE ROBSON CLASSIFICATION SYSTEM IN A SINGLE TERTIARY UNIVERSITY HOSPITAL IN FRANCE

Objective: : To describe trends of delivery by caesarean section (CS), using the Robson classification and to assess maternal and perinatal outcomes accordingly. Design: : Retrospective observational study. Setting: : A tertiary university hospital in Besançon, France. Population : All births at ≥ 22 weeks of gestation from January 1st, 2017, to December 31st, 2023. Methods: : All deliveries were classified using Robson Ten Group Classification System. Main outcome measures : Relative size, CS rate and contribution to the overall CS rate were described for each group. Secondary outcomes were rates of adverse maternal and perinatal outcomes. Results: : A total of 19 082 women were included. The 7-year mean CS rate was 14.4% (n=2753). A significant reduction of the overall CS rate from 15.4% to 13.0% (95%CI 0.5-4.2%) was observed between 2020 to 2023. This reduction was related to a significant reduction in overall CS rate among group 5 and an important trend towards reduction in group 6. An increase in induction rates was observed. Maternal and perinatal outcomes were stable. A significant reduction of neonatal transfer was observed between 2020 and 2023 (1.4%; 95%CI 0.5-2.3%). Conclusions: : CS rate below 15% on average was achieved without increasing maternal and neonatal complications in a tertiary university hospital. Potential target interventions include a better management of women with a previous CS and breech deliveries. Funding : Manon Vouga is supported by Max Cloëtta foundation and Vaudoise Academic Society. Keywords: : Caesarean section, maternal and neonatal outcomes, Robson classification, Ten-Group Classification System, France