Increased rate of C-Section in pregnant women with Rheumatic Diseases - Indications under the magnifying glass: a retrospective cohort study

Objective : To investigate reasons for increased cesarean section (CS) rates in women with systemic lupus erythematosus (SLE) and inflammatory joint diseases (IJD) using the Robson classification. Design : Retrospective single-center cohort study. Setting : RhePro-Study conducted at a tertiary health care centre. Population : A total of 185 women: 119 healthy controls (HC), 40 SLE, and 26 IJD patients. Methods : The study-population was classified according to the Robson system. Mode of delivery and CS indications were compared between groups and categorized as absolute obstetric, relative composite, or rheumatic disease–related. Main Outcome Measures : Robson group distribution, mode of delivery, and CS indications. Results : Women with IJD had significantly fewer spontaneous vaginal deliveries (23.1% vs 54.6%, p = 0.009) and higher CS rates (65.4% vs 37.8%, p = 0.038) than HC. Mode of delivery did not differ significantly between IJD and SLE patients. SLE patients had the highest proportion of absolute obstetric CS indications (78.9%) compared to HC (55.6%) and IJD (23.5%). 64.7% of CSs in IJD patients were performed for relative composite indications. Previous CS was the most common indication for CS overall (25.9%). Conclusions : High CS rates in IJD despite few obstetric indications suggest modifiable clinical decision-making. Neither SLE nor IJD alone necessitates surgical delivery. CS rates should be reduced in rheumatic patients without absolute indications, in line with WHO recommendations.