A study of caesarean section rate by using Robson's ten group classification system at tertiary care hospital, Ahmedabad, India
Keywords:Caesarean section, Caesarean section rate, Robson ten group classification system
Background: Caesarean delivery rate is rising continuously worldwide and is matter of concern. The Robson’s Ten-group classification system allows critical analysis of caesarean deliveries thereby helps to optimise caesarean section rates.
Methods: This study was conducted at GMERS medical college and hospital, Sola, Ahmedabad, Gujarat, India. All patients who delivered between November 2021 and May 2022, were included in the study and were classified in 10 groups according to modified Robson’s classification system. The CS rate and contribution to the overall CS rate was calculated within each group.
Results: Total number of deliveries was 836, out of them 242 was CS. The CS rate was 28.94%. The main contribution to overall caesarean rate was 39.67% by group 5, followed by 17.77% by group 1, 10.33% by group 2. CS rates among various group ranges from 100% among women with abnormal lie (group 9) to 88% in nulliparous breech (group 6), 84.95% in previous CS (group 5), 40.62% in multiparous breech (group 7) and least 3.57% in multipara spontaneous labour (group 3).
Conclusions: The Robson groups 1, 2, 5 and 6 were found to be the major contributors to the overall CS rate. These groups may be targeted for effective interventions to reduce the CS rate. Reduction of primary caesarean delivery, promoting vaginal birth after CS, and careful assessment of cases before induction of labour in nulliparous women, are likely to be a few effective strategies.
Betrán AP, Ye J, Moller AB. The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014. PloS One. 2016;11:e0148343.
Choudhury CR. Caesarean births: the Indian scenario. J Pop Assoc Am. 2008;3:1-8.
World health organization. Appropriate technology for birth. Lancet. 1985;326(8452):436-7.
United Nations Children’s Fund. Available at: https://www.unicef.org/protection/unfpa-unicef-global-programme-end-child-marriage. Accessed on 20 November 2021.
Robson MS. Classification of caesarean sections. Fetal Matern Med Rev. 2001;12:23-39.
Roosenmalen RVJ, Does VCD. Caesarean birth rate worldwide. A search for determinants. Trop Geogr Med. 1995;47(1):19-22.
Thomas J. The National sentinel caesarean section audit report. Available at: http://orca.cf.ac.uk/ 93112/1/nscs_audit.pdf. Accessed on 20 November 2021.
Turcot L, Marcoux S, Fraser WD. Multivariate analysis of risk factors for operative delivery in nulliparous women. Canadian early amniotomy study group. Am J Obst Gynae. 1997;176:395-402.
Betran AP, Gulmezoglu AM, Robson M, Merialdi M, Souza JP, Wojdyla D, et al. WHO global survey on maternal and perinatal health in Latin America: classifying caesarean sections. Reprod Health. 2009;6:18.
Robson MS. Can we reduce the caesarean section rate? Best Pract Res Clin Obstet Gynaecol. 2001;15:179-94.
WHO statement on caesarean section rates. Available at: http://apps.who.int/iris/bitstream/handle/ 10665/161442/WHO_RHR_15.02_eng.pdf?sequence=1. Accessed on 20 November 2021.
Figo WG, Care OM. Best practice advice on the 10-Group Classification System for cesarean deliveries. Int J Gynaecol Obstet. 2016;135(2):232.
Brennan DJ, Robson MS, Murphy M, O’Herlihy C. Comparative analysis of international caesarean delivery rates using 10-group classification identifies significant variation in spontaneous labor. Am J Obstet Gynecol. 2009;201(3):308.e1-8.
Dar MA, Lone SA, Rashid R. Analysis of caesarean section rates by Robson’s classification. J Evid Based Med Health. 2021;8(20):1460-5
Shenoy HT, Shenoy ST, Anaswara T, Remash K. Analysis of caesarean delivery using Robson ten group classification system at a tertiary care teaching institute in Kerala, India. Int J Reprod Contracept Obstet Gynecol. 2019;8:1990-8.