METHODS: Women included in the French National Perinatal Surveys in 2010 and 2016 were classified using maternal characteristics and obstetrical history in 12 groups according to Robson\'s classification (N = 14176 in 2010 and N = 13057 in 2016). We estimated relative size, CD rate and contribution of each group to the global CD rate in 2010 and 2016. Then, we compared the 2 survey years. We analyzed the population characteristics, timing and indications of CD in the groups with significant changes between the two survey years.
RESULTS: The global CD rate was 20.5 % in 2010 and 19.5 % in 2016 (p = 0.027), with a lower pre-labor CD rate (10.9 % versus 9.2 %, p < 0.001). Despite an increasing of maternal age in 2016, we observed a decrease of the relative size of group 2b (nulliparous, singleton, cephalic, term, pre-labor CD): 1.1 % in 2010 versus 0.8 % in 2016 (p = 0.008). Group 5 (previous CD, singleton, cephalic, ≥37 weeks) was the higher contributor to the global CD rate in both 2010 and 2016 (contribution: 5.8 % of the 20.5 % CD rate and 5.4 % of the 19.5 % CD rate, respectively). Despite an increase of BMI in this group, its CD rate significantly decreased between the two years (61.2 % in 2010 versus 55.1 % in 2016, p = 0.001).
CONCLUSIONS: In France, CD rates have decreased between 2010 and 2016, among women having a pre-labor CD and women with a previous CD, in accordance with national guidelines. National guidelines can help mode of delivery decision-making of physicians and impact the national CD rates.