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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.
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

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T1 DM and Pregancy

  • 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