title: Evolution of cesarean categories in a modified Robson classification in a single center from 2002 to 2012 due to high rate of maternal pathology.
abstract: OBJECTIVE
  To study the evolution in cesarean section (CS) categories in a single center from 2002 to 2012.
  
  
  METHODS
  We performed a retrospective study on all live births from 2002, 2007, and 2012 using a modified Robson classification accounting for cervical ripening in the induction groups, post-term pregnancies, and the number of uterine scars.
  
  
  RESULTS
  We recorded 2162, 2105 and 2380 deliveries with caesarean delivery rates of 23.2%, 24.9%, and 30.4% in 2002, 2007, and 2012 respectively. Nulliparous women in spontaneous labor (group 1) decreased from 36.3% to 27.4% of the total population, but CS rates in this group increased from 14.1% to 19.5% (P < 0.05). Labor induction and CS before labor in nulliparous women category (group 2) increased from 6.7% to 14.2% but with stable CS rates. Induction of labor and cervical ripening in this group increased from 91 and nine in 2002 to 119 and 240 in 2012, respectively. In the same period, maternal pathology increased from 11% to 33%. Scarred uterus remained the major source of CS (almost 30% of all CS in 2012).
  
  
  CONCLUSIONS
  CS rates increased throughout the studied period, associated with an increase in rates of maternal pathology, induction by cervical ripening, and scarred uterus.
authors.affiliation: Department of Obstetrics and Gynecology, Pitié-Salpêtrière Hospital, Paris, France.
authors.forename: Aude
authors.initials: A
authors.lastname: Jayot
authors.affiliation: Department of Obstetrics and Gynecology, Pitié-Salpêtrière Hospital, Paris, France.|UPMC Univ Paris 06, Sorbonne Universités, INSERM U1150, CNRS UMR 7222, Paris, France.
authors.forename: Jacky
authors.initials: J
authors.lastname: Nizard
mesh_terms: D001723:Birth Rate; D002585:Cesarean Section / Q000145:classification* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012042:Registries; D012189:Retrospective Studies
keywords: Robson classification; cesarean section; nulliparous women; repeat cesarean section; spontaneous labor