title: Multiple pregnancy is the leading contributor to cesarean sections in in vitro fertilization pregnancies: An analysis using the Robson 10-group classification system.
abstract: OBJECTIVE
  In vitro fertilization (IVF) pregnancy is an important contributor to rising cesarean section (CS) rates. The profile of CS in this group is not well documented. This study sought to identify leading patient categories of the Robson 10-Group Classification System (TGCS) contributing to the high IVF CS rate.
  
  
  METHODS
  We carried out a prospective study of IVF patients who delivered in the Singapore General Hospital from January 2010 to July 2012. Parity, singleton/multiple pregnancy, previous CS, mode of labor onset and gestational age at delivery were collected based on the TGCS. All other deliveries during the study period served as control.
  
  
  RESULTS
  There were a total of 215 IVF deliveries, of which 114 (54.4%) were CS. Group 8 (all multiple pregnancies) was the greatest contributor to the overall CS rate (43.0%). Group 2 (term nulliparous singleton cephalic pregnancies with induction of labor or planned CS) was the second largest contributor to overall CS rate (12.3%). The third and fourth leading contributors were Group 10 (preterm singleton pregnancies) and Group 5 (pregnancies with previous CS), respectively. In contrast, these two groups were top contributors to the overall CS rate for the control group.
  
  
  CONCLUSIONS
  Multiple pregnancy is the principal contributor to CS in our IVF population, and reducing its incidence may reduce its CS rate. Among singleton pregnancies, planned CS and failed induction for cephalic term pregnancies and preterm singleton pregnancies were the next largest contributors, suggesting a higher prevalence of maternal request and high-risk obstetric indications requiring interventions at preterm gestations.
authors.affiliation: Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore.
authors.forename: Jarrod Kah Hwee
authors.initials: JK
authors.lastname: Tan
authors.affiliation: Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore.
authors.forename: Eng Loy
authors.initials: EL
authors.lastname: Tan
authors.affiliation: Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore.
authors.forename: Devendra
authors.initials: D
authors.lastname: Kanagalingam
authors.affiliation: Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore.
authors.forename: Su Ling
authors.initials: SL
authors.lastname: Yu
authors.affiliation: Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore. tan.lay.kok@singhealth.com.sg.
authors.forename: Lay Kok
authors.initials: LK
authors.lastname: Tan
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data; D010298:Parity; D011247:Pregnancy; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data*; D047928:Premature Birth / Q000453:epidemiology; D011446:Prospective Studies; D012846:Singapore / Q000453:epidemiology