Analysis of caesarean sections according to modified Robson’s ten group classification system at a tertiary care centre in Western India
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20190264Keywords:
Caesarean section, India, Induction, Maternal morbidity, Robson classificationAbstract
Background: The increasing trends for Caesarean section (CS) in India and worldwide have been a cause of concern. The aim is to compare and analyse CS rates across the globe, WHO recommends the Robson’s ten group classification system (TGCS). This will help to target appropriate group of women for reduction of overall CS rates.
Methods: This was a retrospective study design using hospital records for women delivered in December 2017. Data was entered and analysed using excel 2007 and presented using modified Robson’s ten group classification system.
Results: Out of total 650 women delivered during the study period, 184 (28.3%) delivered by CS. Group 1 and group 2 included a total of 49.53% women in the present study. The CS rates varied from 100% in group 5 (previous CS), group 7 (breech, multiparous) and group 9 (abnormal lie) to as low as 0.9% in group 3. The present study highlights that group 5 i.e. women with previous CS, contributed maximum (37%) to the overall surgical deliveries with group 2 being the second largest contributor (21%).
Conclusions: The findings of the study indicate that group 5-women with prior CS and group 2-women with induced labour contributed maximum to overall CS rates. TOLAC should be a routine and not optional. Simultaneously Judicious selection of women for induction, strict implementation of induction protocols to decrease the cases of failed inductions will also reduce primary CS. To monitor the CS rates and take appropriate actions it is recommended that Robson’s TGCS be used continuously in all health institutions.
Metrics
References
World Health Organization. Appropriate technology for birth. Lancet. 1985;2:436-7.
Health at a Glance 2011: OECD indicators. OECD Publishing; 2011, Availabe at: http://www.oecd.org/els/health-systems/49105858.pdf.
The alarming increase in caesarean births in India. Livemint, Epaper, Available at: http://www.livemint.com/Politics/z3S7GLR5mayCDE9QokRzsI/The-alarming-increase-in caesarean-births-in-India.html.
Mylonas I, Friese K. Indications for and risks of elective cesarean section. Dtsch Arztebl Int. 2015;112(29-30):489-95.
Souza JP, Gülmezoglu A, Lumbiganon P, Laopaiboon M, Carroli G, Fawole B, et al. Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health. BMC Med. 2010;8:71.
Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS, et al. Maternal mortality and severe morbidity associated with low-risk planned caesarean delivery versus planned vaginal delivery at term. CMAJ. 2007;176:455-60.
Robson MS, Scudamore IW, Walsh SM. Using the medical audit cycle to reduce cesarean section rates. Am J Obstet Gynecol. 1996;174:199-205.
Thomas J, Callwood A, Brocklehurst P, Walker J. The National Sentinel Caesarean Section Audit. BJOG. 2000;107:579-80.
Robson M. Classification of caesarean sections. Fetal Matern Med Rev. 2001;12:23-39.
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.
SOGC COMMITTEE OPINION. Classification of caesarean sections in Canada: the modified Robson criteria. J Obstet Gynaecol Can. 2012;34(10):976-9.
Perinatal Services BC. Examining cesarean delivery rates in British Columbia using the Robson Ten Classification. Part 1: Understanding the Ten Groups. Vancouver, BC; December 2011, Available at: http://www.perinatalservicesbc.ca/NR/ rdonlyres/3CE464BF-3538-4A78-BA51-451987FDD2EF/0/ SurveillanceSpecialReportRobsonTenClassificationDec2011. pdf.
Chong C, Su LL, Biswas A. Changing trends of caesarean section births by the Robson Ten Group Classification in a tertiary teaching hospital. Acta Obstet Gynecol Scand, 2012;91:1422-7.
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;35:206-14.
Robson MS. Can we reduce the caesarean section rate? Best Pract Res Clin Obstet Gynaecol. 2001;15(1):179-94.
Brennan DJ, Robson MS, Murphy M, O'Herlihy C. Comparative analysis of international cesarean delivery rates using 10-group classification identifies significant variation in spontaneous labor. Am J Obstet Gynecol. 2009;201:308.e1-8.
Le Ray C, Blondel B, Prunet C, Khireddine I, Deneux-Tharaux C, Goffinet F. Stabilising the caesarean rate: which target population?. BJOG. 2015;122(5):690-9.
Pereira MN, Leal MC, Pereira AP, Domingues RM, Torres JA, Dias MA, et al. Use of Robson classification to assess cesarean section rate in Brazil: the role of source of payment for childbirth. The Author(s) Reproductive Health. 2016;13(Suppl 3):128.
Kansara V, Patel S, Aanand N, Muchhadia J, Kagathra B, Patel R. A recent way of evaluation of cesarean birth rate by Robson’s 10-group system. J Med Pharmaceut Allied Sci. 2014;01:62-70.
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.
Shirsath A, Risbud N. Analysis of cesarean section rate according to Robson’s 10-group classification system at a tertiary care hospital. Int J Sci Res. 2014;3(1):401-2.
Patel RV, Gosalia EV, KJ, Vasa PB, Pandya VM. Indications and trends of caesarean birth delivery in the current practice scenario. Int J Reprod Contracept Obstet Gynecol. 2014;3:575-80.
Katke RD, Zarariya AN, Desai PV. LSCS audit in a tertiary care center in Mumbai: to study indications and risk factors in LSCS and its effect on early peri-natal morbidity and mortality rate. Int J Reprod Contracept Obstet Gynecol. 2014;3:963-8.
Abdel-Aleem H, Shaaban OM, Hassanin Al, Ibraheem AA. Analysis of cesarean delivery at Assiut University Hospital using the ten group classification system. Int J Gynaecol Obstet. 2013;123(2):119-23.
Wanjari SA. Rising caesarean section rate: a matter of concern? Int J Reprod Contracept Obstet Gynecol. 2014;3:728-31.
Samba A, Mumuni K. A review of caesarean sections using the ten-group classification system (Robson classification) in the Korle-Bu Teaching Hospital (KBTH), Accra, Ghana. Gynecol Obstet. 2016; 6:385.
Brennan DJ, Murphy M, Robson MS, O'Herlihy C. The singleton, cephalic, nulliparous woman after 36 weeks of gestation: contribution to overall cesarean delivery rates. Obstet Gynecol. 2011;117:273-9.