(947) Association between Robson 10 Group Classification (RGC) and the risk adverse maternal and neonatal outcomes

Objective: To analyze the association between the different maternity women groups classified by Robson 10 Group Classification (RGC) and the risk for adverse maternal and neonatal outcomes, at a single large maternity center.

Study Design: An observational study including 235,280 births. Outcomes included post-partum hemorrhage (PPH), puerperal fever, extended length of hospitalization (LOH ≥4 days), maternal readmission within 42 days, in-hospital neonatal mortality, 5-minutes APGAR score < 7 and NICU ≥3 days. The associations and risks were assessed by adjusted logistic regression models for the entire populations as well as by maternal age, background medical condition prior to delivery, GDM, hypertensive disorder during pregnancy, prior miscarriage, gestational age. Analysis was conducted separately by parity. For nulliparous groups, RG1 was a reference for RG 2a, 2b, 6 and 8-10, and for multiparous, RG 3 was a reference for RG 4, 5, 7 and 8-10). In these comparisons, groups 8-10 were selected by their appropriate parity for each analysis.

Results: All multifetal pregnancies (RG8) had the higher risk for PPH (aOR=1.7, 95% CI: 1.4-2.0) and extended LOH (aOR=4.7, 95% CI: 4.0-5.5). RG 2b and 4b; Nulliparous and multiparous pre-labor CS at term, respectively, as well as RG 6; nulliparous breech (unrelated to the mode of delivery), had the highest risk for neonatal mortality (aOR=9.1, 8.0 and 8.0, 95% CI, respectively). Both RG2a and RG4a groups; nulliparous and multiparous single cephalic labor induction at term, markedly showed that labor induction was significantly associated with low 5' APGAR and neonatal mortality, both for nulliparous and multiparous (RG2a low APGAR aOR=1.7 95% CI: 1.4-2.0, mortality aOR =4.2 95% CI: 2.6-6.7. RG4a- low APGAR aOR=3.3 95% CI: 2.7-3.9, mortality aOR=7.7 95% CI: 6.0-9.9) Tables 1 & 2.

Conclusion: The maternal and neonatal risk for adverse perinatal outcome is strongly associated with breech presentation, multifetal pregnancies at any gestational age and labor induction. Focused interventions to these groups may reduce the perinatal adverse outcomes in specific populations.