Robson’s ten group classification: a tool for predicting cesarean section rates

Authors

  • Meghna Tiwari Department of Obstetrics and Gynecology, S.S. Medical College, Rewa, Madhya Pradesh, India https://orcid.org/0000-0001-9564-1211
  • Sanghmitra Singh Department of Obstetrics and Gynecology, S.S. Medical College, Rewa, Madhya Pradesh, India
  • Beenu Singh Kushwah Department of Obstetrics and Gynecology, S.S. Medical College, Rewa, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20230297

Keywords:

CS, Vaginal birth after ceasarean, Fetal distress, Robson’s ten group classification, Failed medical induction

Abstract

Background: Increasing cesarean section delivery rates in India and world is a serious maternal health concern. It is important to understand the trends, reasons behind this change and to find ways to achieve optimum cesaerean section (CS) rates. As per the latest data national family health survey 2019-21 (NFHS 5), CS rates at population level in India seems to be 22% while WHO recommends 10-15% threshold. So, we aim to analyze trend of CS and evaluate it according to Robson’s 10 group classification at tertiary care hospital in Rewa, Madhya Pradesh, India.

Methods: A cross sectional study was conducted at department of obstetrics and gynecology, Shyam Shah medical college Rewa for 3 years from May 2019 to April 2022 on all deliveries occurring on or after 28 weeks of gestation by cesarean section.

Results: Total of 26552 deliveries over 3 years period were analyzed, of these 7484 were CSs (28.18%). Overall C section rate increased from 18.97% in 2019 to 39.95% in 2022. Major contributors to this increase were Robson’s group 5-32.58%, Robson’s group 1-29.45% and Robson’s group 2-12.22%.

Conclusions: Robson’s group 1, 2 and 5 were major contributors to overall increased cesarean section rates. Fetal compromise, meconium aspiration risk, obstructed labor and cesarean scar tenderness were underlying indications for most of the cesarean sections done. Efforts should be made to implement standard protocol to reduce primary cesarean section rates.

References

Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR et al. The increasing trend in caesarean section rates: Global, regional and national estimates: 1990-2014. J Pone. 2016;11(2).

World Health Organization Human Reproduction Programme. WHO Statement on caesarean section rates. Reprod Heal Matters. 2015;23(45):149-50.

Ye J, Zhang J, Mikolajczyk R, Torlani MR, Gulmezoglu AM, Betran AP. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: A worldwide population-based ecological study with longitudinal data. BJOG. 2016;123(5):745-53.

Betran AP, Torlani MR, Zhang J, Ye Z, Mikolajczyk R, Tharaux CD et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Heal. 2015;12(57):43-6.

Reproductive health: Managing complications in pregnancy and childbirth: A guide for midwives and doctors. World Health Organization 2003. Available at: https://apps.who.int/iris/handle/10665/42644. Accessed on 12 Nov, 2022.

Rijken MJ, Meguid T, Akker VDT, Roosmalen V, Stekelenburg J, Dutch Working Party for International Safe Motherhood and Reproductive Health. Global surgery and the dilemma for obstetricians. Lancet (London, England). 2015;386(10007):1941-2.

Belachew J, Cnattingius S, Mulic-Lutvica A, Eurenius K, Axelsson O, Wikstrom AK. Risk of retained placenta in women previously delivered by caesarean section: A population-based cohort study. BJOG. 2013;121(12):224-9.

Kok N, Ruiter L, Hof M, Ravelli A, Mol BW, Pajkrt E et al. Risk of maternal and neonatal complications in subsequent pregnancy after planned caesarean section in a first birth, compared with emergency caesarean section: A nationwide comparative cohort study. BJOG. 2014;121(2):216-23.

Villar J, Carroli G,Zavaleta N, Donner A, Wojdyla D, Faundes A et al. Maternal and neonatal individual risks and benefits associated with caesarean delivery: Multicentre prospective study. BMJ. 2007;335(7628):1025.

Tsega F, Mengistie B, Dessie Y, Mengesha MM. Prevalence of Cesarean Section in Urban Health Facilities and Associated Factors in Eastern Ethiopia: Hospital Based Cross Sectional Study. J Preg Child Heal. 2015;2:169-73.

Johnson CT, Johnson TRB, Adanu RMK, Debas HT, Donkor P, Gawande A et al (Eds). Obstetric Surgery. Essential Surgery: Disease control priorities (3rd ed) 1. International Bank for Reconstruction and Development/ the World Bank. 2015.

Robson MS. Can we reduce the caesarean section rate? Best Pract ReS. Clin Obstet Gynaecol. 2001;15(1):179-94.

Prameela RC, Shilpa G, Farha A, Prajwal S. Analysis of Cesarean section rate using Robson’s Ten Group Classification System and comparing the trend at a tertiary hospital for 2 years. J South Asian Federation Obstetr Gynaecol. 2016 8(3):175-80.

Cesarean section rates continue to rise amid growing inequalities in access. Rising rates suggest increasing numbers of medically unnecessary, potentially harmful procedures 2021 June 16. Available at: http://https://www.who.int/news/item/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access. Accessed on 12 November, 2022.

Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Heal. 2019;6(6).

Radhakrishnan TR, Vasanthakumari KP, Babu PK. Increasing trend of caesarean rates in India: Evidence from NFHS-4. JMSCR. 2017;5(8):26167-76.

Jain R, Joshi V. Analysis of caesarean section using the Robson’s ten group classification system -a way of monitoring obstetric practice. New Indian J OBGYN. 2021;9(1):71-7.

Reddy AY, Dalal A, Khursheed R. Robson Ten Group Classification System for analysis of cesarean sections in an Indian Hospital. Res J Obstet Gynecol. 2018;11(1):1-8.

Dhodapkar SB, Bhairavi S, Daniel M, Chauhan NS, Chauhan RC. Analysis of caesarean sections according to Robson’s ten group classification system at a tertiary care teaching hospital in South India. Int J Reprod Contracept Obstet Gynecol. 2015;4:745-9.

Loué VA, Gbary EA, Koffi SV, Koffi AK, Traore M, Konan JK et al. Analysis of caesarean rate and indications of university hospitals in sub-Saharan African developing countries using Robson classification system: The case of Cocody’s hospital center, Abidjan-Cote d’Ivoire. IJRCOG. 2017;5:1773-7.

Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J et al. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Heal. 2015;3(5):260-70.

Kelly S, Sprague A, Fell DB, Murphy P, Aelicks N, Guo Y et al. Examining caesarean section rates in Canada using the Robson classification system. J Obstet Gynaecol Can. 2013;35(3):206-14.

Kazmi T, Saiseema S, Khan S. Analysis of cesarean section rate-according to Robson’s 10-group classification. Oman Med J. 2012;27(5):415-7.

Pati T, Marandi S, Mohapatra S. Analysis of caeserian section rate using Robson’s classification in a tertiary care hospital of eastern Odisha. JMSCR 2018;6(9):157-161.

Gomathy EG, Radhika K, Kondareddy T. Use of the Robson classification to assess caesarean section trends in tertiary hospital. Int J Reprod Contracept Obstet Gynecol. 2018;7(5):1796-800.

Sungkar A, Santoso BI, Surya R, Fattah AN. Classifying cesarean section using Robson classification: an Indonesian tertiary hospital survey. Maj Obs Gin. 2019;27(2):66-7.

Downloads

Published

2023-02-04

Issue

Section

Original Research Articles