Robson Ten Group Classification System Applied to Women with Severe Maternal Morbidity

• Published in: Birth (Berkeley, Calif.) Calif.), 2015-03, Vol.42 (1), p.38-47
• Main Authors: Ferreira, Elton Carlos, Costa, Maria Laura, Cecatti, José Guilherme, Haddad, Samira M., Parpinelli, Mary Angela, Robson, Michael S.
• Format: Article
• Language: English
• Subjects: Brazil; cesarean delivery; Cesarean Section - statistics & numerical data; classification of cesarean delivery; Clinical outcomes; Cross-Sectional Studies; Delivery, Obstetric - statistics & numerical data; Female; Humans; maternal near miss; Morbidity; Obstetrics; Pregnancy; Pregnancy Complications - classification; Pregnancy Complications - diagnosis; Pregnancy Complications - mortality; Prognosis; severe maternal morbidity; Severity of Illness Index; Womens health
• ISSN: 0730-7659; 1523-536X
• DOI: 10.1111/birt.12155

Objective To evaluate the distribution of women with severe maternal morbidity according to Robson Ten Group Classification System (RTGCS). Methods Secondary analysis of a multicenter cross‐sectional study in 27 obstetric units in Brazil, using RTGCS. Cases were classified into potentially life‐threatening condition or a maternal near miss or death, according to severity. Certain groups were subdivided for further analysis. Cesarean delivery (CD) rates were reported. Results Among 7,247 women with severe maternal morbidity, 73.2 percent underwent CD. Group 10 (single, cephalic, preterm) was the most prevalent (33.9%). Groups mostly associated with a severe maternal outcome were: 7 (multiparous, breech), 9 (all abnormal lies, single, term), 8 (all multiple), and 10. Groups 1 (nulliparous, single, cephalic, term, spontaneous) and 3 (multiparous, single, cephalic, term, spontaneous) were associated with better maternal outcome. Group 3 had one severe maternal morbidity to 29 cases of potentially life‐threatening, but the ratio was 1:10 for women undergoing CD, indicating a worse outcome. Group 4a (multiparous, no previous CD, single, cephalic, term, induced labor) had a better maternal outcome than those delivered by CD before labor (group 4b). Hypertension was the most common condition of severity. Conclusions The RTGCS was useful to consider severe maternal morbidity, showing groups with higher CD rates and worse maternal outcomes.