Evaluation of caesarean section practices according to Robson's 10-group classification at a level two maternity ward in Conakry, Guinea

Daniel W. A. Leno, Mamoudou E. Bah, Jerry C. Moumbagna, Tamba M. Millimouno, David Lamah, Alexandre Delamou, Telly Sy


Background: The frequency of caesarean sections (CS) increased dramatically in the world over the last twenty years. The objective of this study was to evaluate caesarean section practices based on Robson classification in an urban referral hospital in Conakry, Guinea

Methods: We conducted a cross-sectional study of 2,266 birthing records collected at the maternity ward of the Coronthie Communal Medical Center in Conakry, from January 1st to December 31st 2016. We included in the study all women who had a caesarean section and whose medical records were complete. Robson's classification was used to classify women into 10 groups based on maternal and fetal characteristics. The relative size of each group, its gross caesarean section rate as well as its contribution to overall caesarean section rate and the main caesarean section indications were calculated.

Results: In 2016, 769 caesarean sections were performed out of 2,266 deliveries, corresponding to a hospital section rate of 33.9%. Groups 5 (11.0%), 1 (4.8%), and 3 (4.3%) of the Robson classification were the most contributors to registered hospital caesarean section rate. The main indications for caesarean section were uterine scar in group 5 and acute fetal distress in groups 1 and 3.

Conclusions: The systematic reference to the Robson classification could help to identify and avoid the relative indications of the caesarean section in urban Guinea. Besides, increasing induction of labor and strengthening providers’ capacities in emergency obstetric and newborn care services could contribute to reduce caesarean section rates in Guinea.


Evaluation, Caesarean section, Conakry, Guinea, Level two maternity, Robson classification

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Vogel JP, BetraÂn 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 GlobHealth. 2015;3:260-70.

Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and national estimates: 1990±2014. PloS One. 2016;11:e0148343.

Blondel B, Lelong N, Kermarrec M, Goffinet F. Trends in perinatal health in France between 1995 and 2010: Results from the National Perinatal Surveys. J Gynecol Obstet Biol Reprod. 2012;41:151-66.

Cissé CT, Ngom PM, Guissé A. Reflections on the evolution of caesarean section rates in Africa: example of the Dakar University Hospital Center between 1925 and 2001. Gynecol Obstet Fertil. 2004;32:210-7.

Ministry of Health. Needs assessment of emergency obstetric and newborn care in republic of Guinea. Final report. Ministry of Health; 2013.

Keita N, Diallo FD, Gandaho E, Leno DWA. Caesarean section in Africa: Example from Guinea. French national college of obstetricians and gynecologists, Fourth part. Gynecology-obstetrics of the world, 38th national days, Paris; 2014:337-346.

Robson MS. Can we reduce the caesarean section rate? Best Pract Res Clin Obstet Gynaecol. 200;15:179-94.

Robson M, Hartigan L, Murphy M. Methods of achieving and maintaining an appropriate caesarean section rate. Best Pract Res Clin Obstet Gynaecol. 2013;27:297-308.

World Health Organization. Robson classification: Implementation manual. 2017. Available at:;jsessionid=8763FB EBBD12B2CADC7FC4CE085500B1?sequence=1. Accessed on 1st August 2019.

Mbaye M, Gueye M, Gueye MDN, Niang NKS, Moreau JC. Analysis of cesarean section rate according to Robson’s classification in an urban health centre in Senegal. Int J Reprod Contracept Obstet Gynecol. 2015;4:1100-2.

Le Ray C, Prunet C, Deneux-Tharaux C, Goffinet F, Blondel B. Robson classification: A tool for assessing caesarean section practices in France. J Gynecol Obstet Biol Reprod. 2015;44:605-13.

Haydar A, Vial Y, Baud D, Desseauve D. Evolution of the caesarean sections rate in a Swiss university maternity hospital according to Robson classification. Rev Med Suisse. 2017;13:1846-51.

Nakamura-Pereira M, Carmo LM, Esteves-Pereira AP, Domingues RMSM, Alves Torres J, Bastos Dias MA et al. Use of Robson classification to assess cesarean section rate in Brazil: the role of source of payment for childbirth. Repro Health. 2016;13(Suppl. 3):245-56.

Mbungu MR, Ntela MJ, Kahindo MP. Frequency of caesarean sections according to Robson classification in 3 maternity wards in the city of Kinshasa, Democratic Republic of Congo. Ann Afr Méd. 2017;10(2):2535-44.

Studsgaard A, Skorstengaard M, Glavind J, Hvidman L, Uldbjerg N. Trial of labor compared to repeat cesarean section in women with no other risk factors than a prior cesarean delivery. Acta Obstet Gynecol Scand. 2013;92:1256‑63.

Guise JM, Berlin M, Mc Donagh M. Safety of vaginal birth after cesarean: a systematic review. Obstet Gynecol. 2004;103:420-9.

Main EK, Moore D, Farrell B. Is there a useful cesarean birth measure? Assessment of the nulliparous term singleton vertex cesarean birth rate as a tool for obstetric quality improvement. Am J Obstet Gynecol. 2006;194:1644-51.

Duruelle P, Lepage J, Depret S, Clouqueur E. Mode of labour induction and labour conducting in case of uterine scar. J Gynecol Obst Biol Reprod. 2012;41(8):788-802.

Delivery in women with previous cesarean section or other uterine surgery: guidelines for clinical practice - text of the guidelines (short text). J Gynecol Obstet Biol Reprod (Paris). 2012;41:824-30.