This study analyzed the Caesarean section (CS) rate in 300 women with type 1 diabetes (T1DM) who delivered at a large tertiary hospital using the Robson criteria for meaningful comparisons. The overall CS rate was 58% for women with T1DM, significantly higher than the institutional rate of 19.6%. Nulliparous women who underwent labor induction had a higher CS rate of 48.5% compared to 11.5% for multiparous women. Women with a previous CS usually required repeat CS for subsequent deliveries. High rates of labor induction, especially in nulliparous women, contributed to the high overall CS rates in women with T1DM.

1. Examination of the Caesarean Section Rate in Type I
Diabetes: Use of the Robson Criteria to allow
meaningful analysis of data
C Carroll, W Courtney, M Higgins, M Robson, F McAuliffe, M Foley
The aim of this study was to investigate the rate of caesarean section (CS) in
women with type 1 diabetes (T1DM) attending a large tertiary level unit using
the Robson Groups, and whether induction truly confers a higher CS delivery
rate. The Robson Groups are internationally recognized as a method of
meaningful analysis and comparison of CS rates.
Methods
Prospective study in a tertiary level unit with a large combined diabetic – obstetric
service. Clinical data was recorded from multiple databases and cases assigned
to their relevant Robson Group.
Results
Between January 2005 and December 2012, 300 women with T1DM delivered in
this institution. The CS delivery rate in T1DM was 58% (vs, institutional CS rate
of 19.6%). Nulliparous women undergoing induction of labour (Groups 2a and
4a) had an increased CS delivery rate (48.5% in nulliparous vs 11.5% in
multiparous women). The vast majority of women with a previous CS delivered
by repeat CS (97%). Those who presented in spontaneous labour with T1DM
had a 6 to 25-fold increase in delivery by CS compared to the general population,
though the absolute numbers are small.
Conclusion
This study analysed CS rates in T1DM women, confirming that high rates of
induction of labour results in high rates of delivery by CS, especially in
nulliparous women. Women with T1DM previously delivered by CS usually
required a repeat CS delivery in subsequent pregnancies. With such high rates of
delivery by CS, the case may be for planned elective CS in women with diabetes.

2. Robson Group
Number
of
patients
Number of
CS
CS Rate in
T1DM (%)
CS Rate in
General
Population
(%)
1
Nulliparous, single cephalic
>37 weeks in spontaneous
labour
15 5 33.3
7.16
2 108 56 51.8 33.60
2a
Nulliparous, single cephalic
>37 weeks in induced labour
101 49 48.5 28.87
2b
Nulliparous, single cephalic
CS before labour
7 7 100 100.00
3
Multiparous, single cephalic
>37 weeks in spontaneous
labour
10 3 30 1.20
4 62 16 25.8 12.46
4a
Multiparous, single cephalic
>37 weeks in induced labour
52 6 11.5 5.48
4b
Multiparous, single cephalic
>37 weeks CS before labour
10 10 100 100.00
5
Previous CS, single cephalic
>37 weeks
72 70 97.2 58.66
6
All nulliparous breeches
1 1 100 92.46
7
All multiparous breeches
(incl. previous CS)
1 1 100 84.05
8
All multiple pregnancies
(incl. previous CS)
7 5 71.4 60.72
9
All abnormal lies (incl.
previous CS)
1 1 100 100.00
10
All single, cephalic, <=36
weeks (incl. previous CS)
23 18 78.2 34.64
Total 300 176 58.67 19.67