DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20181905

Use of the Robson classification to assess caesarean section trends in tertiary hospital

Gomathy Gomathy E., Kondareddy Radhika, Triveni Kondareddy

Abstract


Background: With caesarean sections on the rise WHO proposes that health care facilities use the Robson's 10 group classification system to audit their C-sections rates. This classification would help understand the internal structure of the CS rates at individual health facilities identify key population groups, indications in each group and formulate strategies to reduce these rates.

Methods: This was a cross sectional study for a period of 6 months at a tertiary care hospital in a rural area in Karnataka, South India. Women who delivered during this period were included and classified into 10 Robson's classes and percentages were calculated for the overall rate, the representation of groups, contribution of groups and Caesarean percentage in each group.

Results: Highest contribution was by Group 5 and Group 2. Together these two groups contributed to 50.3% of the total Caesareans. Followed by Group 1 and 10. A Groups 6, 4, 8 and 9 by themselves did not contribute much but within their groups had a 100% C-section rate.

Conclusions: Robson 10-group classification provides easy way in collecting information about Caesarean section rate which obtains good insight into certain birth groups. Reducing primary section rates, adequate counselling and encouraging for VBAC, changing the norms for non-reassuring fetal status, training and encouraging obstetricians to perform versions when not contraindicated could reduce the contribution of Robson's groups towards the absolute C-Section rates.


Keywords


Caesarean section, Robson’s classification

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References


UNICEF. The State of the World’s Children 2013. New York: UNICEF. 2013. Available at http://www.unicef.org/sowc2013/ Accessed 23rd March, 2015.

World Health Organization. Monitoring emergency obstetric care: a handbook. Geneva, Switzerland. 2009. Available at http://apps.who.int/iris/bitstream/handle/10665/44121/9789241547734_eng.pdf?sequence=1

Althabe F, Belizan JM. Caesarean section: the paradox. (comment). Lancet. 2006;368(9546):1472-3.

Robson M. Classification of caesarean sections. Fetal Matern Med Rev. 2001;12:23-39.

Robson M. Can we reduce the caesarean section rate? Best Pract Res Clin Obstet Gynaecol. 2001;15:179-94.

Torloni MR, Betran AP, Souza JP, Widmer M, Allen T, Gulmezoglu M, et al. Classifications for cesarean section: a systematic review. PLoS One. 2011;6:e14566

Hartmann K, Andrews J, Jerome R, Lewis R, Likis F, McKoy J, et al. Strategies to reduce cesarean birth in low-risk women. Agency Healthcare Res Qual (US) Rep No. 2012;12(13):EHC128-EF.

Betr´an AP, Vindevoghel N, Souza JP, G¨ulmezoglu AM, Torloni 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(6):e97769.

World Health Organization, WHO Statement on Caesarean Section Rates, WHO/RHR15.02, World Health Organization, Geneva, Switzerland. 2015. Available at http://apps.who.int/iris/bitstream/handle/10665/161442/WHO_RHR_15.02_eng.pdf?sequence=1

Figo WG, Care OM. Best practice advice on the 10-Group Classification System for cesarean deliveries. Int J Gynaecol Obstet. 2016;135(2):232.

Thomas J. The National Sentinel Caesarean Section Audit Report. London RCOG Press. 2001.Available at http://orca.cf.ac.uk/93112/1/nscs_audit.pdf

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.

Keisuke T, Kassam M. The ten-group robson classification: a single centre approach identifying strategies to optimise caesarean section rates. Obstet Gynecol Int. 2017:5648938.

Ray A, Jose S. Analysis of caesarean-section rates according to Robson's ten group classification system and evaluating the indications within the groups. IJRCOG. 2017;6(2):447-51.

Prameela RC, Farha A, Bhanumati P, Prajwal S. Analysis of caesarean section rate in a tertiary hospital: according to Robson’s 10 Group Classification System (TGCS). IOSR Journal of Dental and Medical Sciences. 2015;14(2):46-9.

National Institute for Health and Care Excellence. Inducing labour. 2008. Available at http://www.nice.org.uk/guidance/cg70.

Leduc D, Biringer A, Lee L. Induction of labour. J Obstet Gynaecol Canada. 2013;35(9),840-57.

Lydon-Rochelle MT, C´ardenas V, Nelson JC, Holt VL, Gardella C, Easterling TR. Induction of labor in the absence of standard medical indications: incidence and correlates. Medical Care. 2007;45(6):505-12.

Wood S, Cooper S, Ross S. Does induction of labour increase the risk of caesarean section? a systematic review and meta-analysis of trials in women with intact membranes. Int J Obstet Gynaecol. 2014;121(6):674-85.

Mishanina E, Rogozinska E, Thatthi T, Uddin-Khan R, Khan KS, Meads C. Use of labour induction and risk of cesarean delivery: a systematic review and meta-analysis. CMAJ. 2014;186(9):665-73.

Zhang J, Troendle JF, Yancey MK. Reassessing the labor curve in nulliparous women. Am J Obstet Gynecol. 2002;187(4):824-8.

Zhang J, Landy HJ, Branch DW. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol. 2010;116(6):1281-7.

Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomized multicenter trial. The Lancet. 2000;356(9239)1375-83.

Rietberg CC, Elferink-Stinkens PM, Visser GH. The effect of the term breech trial on medical intervention behaviour and neonatal outcome in The Netherlands: an analysis of 35,453 term breech infants. Int J Obstet Gynaecol. 2005;112(2):205-9.

Hehir MP. Trends in vaginal breech delivery. J Epidemiol Community Health. 2015;69(12):1237-9.

Daviss BA, Johnson KC, Lalonde AB. Evolving evidence since the term breech trial: Canadian response, European dissent, and potential solutions. J Obstet Gynaecol Canada. 2010;32(3):217-24.

Kotaska A. Inappropriate use of randomized trials to evaluate complex phenomena: case study of vaginal breech delivery. BMJ. 2004;329:1029-42.

Glezerman M. Five years to the term breech trial: the rise and fall of a randomized controlled trial. Am J Obstet Gynecol. 2006;194(1):20-5.