In Reply We agree with Dr Uzoigwe and colleagues that for individual patients, cesarean delivery should be performed only when indicated. We are glad that WHO has moved away from a target rate. We also agree that institutions should consider using a clinical classification system such as the Robson Ten Group Classification System1 to prospectively categorize laboring women and to compare processes and outcomes for these groups. The Robson Ten Group Classification System is a set of easily collected criteria that can assess various risk groups in pregnancy. Factors captured are parity, presentation, maturity of pregnancy, multiple pregnancies, and prior cesarean delivery. This information will allow for a much more nuanced understanding of the role of cesarean delivery in maternal and neonatal health and potentially development of “risk-adjusted” cesarean delivery rates on a population level. Furthermore, a recent systematic review concluded that the Robson Ten Group Classification System would be the best set of clinical metrics to use internationally.2 However, these data are not currently widely collected. We support efforts to collect data on cesarean delivery stratified by this or other scales.
Molina G, Weiser TG, Haynes AB. Maternal and Neonatal Mortality After Cesarean Delivery—Reply. JAMA. 2016;315(18):2017. doi:10.1001/jama.2016.0927