Discussion
Main findings
Rates of CS are rising worldwide, but determinants of this increase remain controversial. In particular, despite the utility of TGCS in allowing standardized comparisons thus helping to define strategies to reduce CS rates, it does not account for several maternal and fetal clinical variables that can potentially affect the mode of delivery4. For instance, advanced maternal age, obesity, macrosomia, diabetes and hypertension are well-known RFs for CS5-11. Others, like epidural analgesia and immigrant status have a more controversial relationship12, 13. In this study we aimed to estimate the impact of obstetric and maternal-fetal variables in affecting CS rate in different Robson groups and to analyse the trends of CS rates in the given period in our Unit. We found that all the considered variables (advanced maternal age, diabetes, hypertension, fetal macrosomia, obesity, epidural analgesia, and immigrant status) altered the CS rate at least in one Robson group. Nevertheless, they differently influenced the CS rate in relation to the Robson groups. Moreover, we found that the rate of CS in the last 24 years decreased significantly in Robson groups 2A, 5 and 10.