ANALYSIS OF CAESAREAN SECTION RATE ACCORDING TO ROBSON CLASSIFICATION CRITERIA: A CROSS SECTIONAL STUDY IN A TERTIARY CARE HOSPITAL.
DOI:
https://doi.org/10.47672/ajhmn.1009Keywords:
Caesarean section, Robson Ten Group Classification.Abstract
Purpose: The World Health Organization, recommends the Robson Ten Group Classification System (RTGCS) as a global standard for assessing, monitoring and comparing CS rates at both national and international levels. This study was aimed to analyze CS rate in Department of Obstetrics and Gynaecology MTI, LRH, Peshawar; according to RTGCS. This will help understand the major contributory groups to the overall CS rate and to formulate strategies to optimize the escalating rates.
Methodology: A cross-sectional study for a period of 1 year from 1st January 2021 to 31st December 2021 was conducted at a tertiary care hospital located in the capital city of KPK Province, Pakistan. Women (n=7376) who delivered during the study period, fulfilling the inclusion/exclusion criteria were included. All relevant obstetric information was entered into a structured proforma. The study population was classified into Robson 10 groups and percentages were calculated for the overall CS rate, the representation of groups and contributions of the each group to the total CS rate.
Findings: A total of 7376 deliveries were analyzed as per RTGCS. Of these 1679 (22.76%) were caesarean sections. According to the criteria used, Group I & III represented more than half (53.75%) of the obstetric population. The major contributor to the overall CS rate was group V (Previous caesarean delivery, single, cephalic > or equal to 37weeks), followed by group I (Nulliparous, single, cephalic > or equal to 37 weeks, in spontaneous labour), group X (All singleton, cephalic, < 37 weeks gestation pregnancies-including previous CS) and group III.
Conclusion: The implementation of RTGCS at MTI, LRH, Peshawar helped to identify the contribution of each group to the overall CS rate. Group V was the leading contributor to the overall CS rate. This study also revealed a high rate of CS among low risk groups i.e. group I and III.
Recommendations: Current study can be used to compare results among the institutions at provincial and national levels to design uniform policies throughout the Pakistan to optimize CS rate. Furthermore, education for both pregnant women and obstetricians is required to encourage and promote ECV and VBAC to avoid repeat Caesarean sections. Moreover, the instrumental vaginal delivery should be encouraged where clinically indicated and justified
Downloads
References
Fatima SS, Gillani S, Naib J, Sharafat Z. Antimicrobial sensitivity patterns of bacterial isolates from surgical site infections in obstetrics and gynaecology. Journal of Medical Sciences.2013; 21(4): 201-205.
Gomathy E, Radhika K, Kondareddy T. Use of the Robson Classification to assess C-section trends in tertiary hospital. Int J Reprod Contracept Obst gynacol 2018; 7 (5):1796-1800.
Yadav RG, Maitra N. Examining caesarean delivery rates using the Robson 10 group classification. The J of Obst and gynecol of India 2016; 66:1-6.
Abubeker FA, Gashawbeza B, Gebre TM, Wondafrash M, Teklu AM et al. Analysis of caesarean section rates using Robson ten group classification system in a tertiary teaching hospital, Addis Ababa, Ethiopia: a cross-sectional study.BMC Pregnancy and Childbirth.2020;20: 767.
Vogel JP, Betran AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, et al. Use of Robson classification to assess caesarean section trends in 21 Countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health.2015; 3:260-270.
Alsulami SM, Ashmawi MT, Al-Jifree HM. The rates of caesarean section deliveries according to ROBSON classification system during year 2018 among patients in King Abdul Aziz Medical city, Jeddah, Saudi Arabia. Cureus.2020; 12(11): e11529.
Maso G, Alberico S, Monasta L, Ronfani L, Montico M, Businelli C, et al.The application of the Ten Group classification system in caesarean delivery case mix adjustment. A multicentre prospective study. Plos one. 2013; 8:e62364.
Betran AP, Vindevoghel N, Souza JP, Gulmezoglu AM, Tolono MR. A systematic review of the Robson classification for caesarean section :what works, doesn’t work and how to improve it. Plos one.2014; 9: e 97769.
Kant A, Mendiratta S. Classification of caesarean section through Robson criteria, an emerging concept to audit the increasing caesarean rate. Int J Reprod Contracept Obstet Gynecol 2018; 7(11):4674-77.
Ansari A, Baqai S, Rabia Imran R.An audit of Caesarean Section Using modified robson criteria at a tertiary care hospital. J of the college of physians and surg Pak.2019;29(8):768-770.
Torloni MR , Betran AP, Souza JP, Widmer M, Allen T, Gulmezogiu M, et al. Classification for caesarean section : a systematic review. Plos one.2016:e14566.
Figo WG, Care OM. Best practice advice on the 10 group classification system for caesarean deliveries. Int J Gynecol obstet 2016; 135 (2):232.
Hartmann K, Andrew J, Jerome R, Lewis R, et al. Strategies to reduce caesarean birth in low risk women. Agency health care Res Qual (US).Rep No.2012; 12(13): EHC 128-EF.
Schemann K, Patterson JA, Nippita TA, Ford JB, Roberts CL. Variation in hospital caesarean section rates for women with at least one previous caesarean section: a population based cohort study. BMC Pregnancy Childbirth.2015; 15:179.
Gilani S, Mazhar SB, Zafar M, Mazhar T. The modified Robson criteria for caesarean section audit at Mother and Child Health Centre Pakistan Institute of Medical Sciences Islamabad. 2020; 70(2): 299-303.
WHO, UNFPA, UNICEF, AMDD. Monitoring emergency obstetric care: a hand book. Geneva: world Health Organization; 2009.
Sah S, Goel R, Goel JK. Analysis of caesarean section rate according to Robson’s criteria in tertiary care centre. Int J of Repro Contra Obst Gynecol.2018; 7(8):3060-4.
Costa ML, Cecatti JG, Souza JP, Milanez HM. Using a caesarean section classification system based on characteristics of the population as a way of monitoring obstetrics practice. Repro Health.2010; 7:13.
Litorp H, Kidanto HL, Nystrom L, Darj E, Essen B. Increasing caesarean section rates among low-risk groups: a panel study classifying deliveries according to Robson at a university hospital in Tanzania. BMC Pregnancy Childbirth.2013; 13:107.
Triunfo S, Ferrazzani S, Lanzone A, Scambia G. Identification of obstetric targets for reducing caesarean section rate using the Robson ten group classification in a tertiary level hospital.2015;189:91-5.
Stavrou EP, Ford JB, Shand AW, Morris JM, Roberts CL. Epidemiology and trends for caesarean section births in New South Wales, Australia: a population based study.BMC Pregnancy Childbirth 2011;11:8.
MacDorman MF, Menacker F, Declercq E.Caesarean birth in the United States; Epidemiology, trends and outcomes. Clin Perinatol 2008.Jun; 35(2):239-307.
Lumbiganon P, Attygalle DE, Shrestha N, Mori R, Nguyen DH. Methods of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08. Lancet 490-99.
Yazdizadeh B, Nedjar S, Muhammad K, Rashidian A, Changizi N, Majdzadeh R. Caesarean section rate in Iran, multi-dimensional approaches for behavioural change of providers: a qualitative study.BMC Health Service Res 2011;11:159.
Kolas T, Hofoss D, Daltveit AK, Nilsen ST, Henriksen T, Hager R, et al . Indications for caesarean deliveries in Norway. Am J Obstet Gynecol 2003. April; 188(4):864-70.
Zimmo MW, Laine K, Hassan S, Bottcher B, Fosse E, Ali Masri H et al. Caesarean section in Palestine using the Robson ten group classification system: a population – based birth cohort study.BMJ.2018;8(10): e 0228754.
Tura AK, Pijpers O, de Man M, Cleveringa M,Koopmans I,Gure T. Analysis of caesarean sections using Robson 10 group classification in a university hospital in eastern Ethiopia: a cross sectional study.BMJ open (4), e020520, 2018.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Syeda Sitwat Fatima, Laila Zeb, Tanveer Shafqat, Qudsia Qazi
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work’s authorship and initial publication in this journal.
