Analysis of caesarean section using Robson’s ten group classification system - a way of monitoring obstetric practice

ISSN Print – 2454-2334; ISSN Online – 2454-2342 DOI - 10.21276/obgyn.2022.9.1.14 RESEARCH ARTICLE Analysis of caesarean section using Robson’s ten group classification system - a way of monitoring obstetric practice Renu Jain, Vrunda Joshi Corresponding author: Dr. Renu Jain, Associate Professor, Department of Obstetrics and Gynaecolgy, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India; Email : Distributed under Attribution-Non Commercial – Share Alike 4.0 International (CC BY-NC-SA 4.0) ABSTRACT Aim: The aim of the present study was to calculate the overall cesarean section rate, to identify groups of women (distributed according to Robson’s Ten Group classification system) that contributed most to the overall cesarean section rate and to analyze cesarean section rates within groups in our institute. Methods: A cross-sectional study was conducted for a period of 1year from January 2019 to December 2019. All pregnant women with gestational age of more than 28 weeks, delivered during the study period were classified according to Robson’s ten-group classification system. Cesarean section rate, group size, group cesarean section rate and absolute and relative contribution of each group to caesarian section (CS) rate were calculated and analysis was done. Results: The overall cesarean section rate was 42.39%. Group 3 included multiparous women (excluding previous cesarean section), with single pregnancy cephalic, at term in spontaneous labour, was the largest group (group size 29.87%). The second largest group was group 1 included nulliparous women with single pregnancy cephalic at term (group size 23.49%), with a CS rate of 34.51%. Group 5, which consists of multiparous women, with at least one previous section and single pregnancy in a cephalic presentation at term, was the largest contributor to overall caesarean section rate (38.69%). Conclusion: Women with previous cesarean section constitute the most important determinant of overall cesarean section rates. Decreasing the primary caesarean section rates is the key to reducing overall caesarean section rates. Keywords: Cesarean section, Robson classification. The crude rate of cesarean section is an important indicator for measuring access to obstetric services. Rising caesarean section rates have been observed worldwide in recent decades, but determinants of this increase are controversial. Cesarean delivery has higher maternal risks for the current and subsequent pregnancies compared with spontaneous vaginal birth 1. The frequencies of some maternal complications which include anaesthetic complications 2, hemorrhage, infection, injury to adjacent organs and thromboembolism are increased with caesarean sections as compared with vaginal deliveries 3. For women undergoing subsequent caesarean, these maternal risks are even greater. The incidence of placenta previa increases. There is an increased risk of placenta accrete and hysterectomy 4. For the neonate, it offers lower rates of birth trauma and still birth but greater rates of initial respiratory difficulties 1. Many classification systems have been proposed by different authors for classifying caesarean sections. In 2001 Michael Robson introduced “Robson’s ten group classification system” for classifying caesarean sections. The WHO statement (Geneva 2014) proposes the use of “Robson’s ten group classification system” as the global standard for assessing, monitoring and comparing caesarean section rates within health care facilities 5. The Robson classification is for “all women” who deliver at a specific setting and not only for the women who deliver by cesarean section. It is a complete perinatal classification. Received: 6th April 2021, Peer review completed: 20th May 2021, Accepted: 21st July 2021. Jain R, Joshi V. Analysis of caesarean section using the Robson’s ten group classification system - a way of monitoring obstetric practice. The New Indian Journal of OBGYN. 2022; 9(1): 71-7. The New Indian Journal of OBGYN. 2022 (July-December);9(1) It provides a framework for monitoring and auditing CS rates. It is based on four obstetric concepts: category of pregnancy, previous obstetric history, course of pregnancy and gestational age. On this basis women are categorized into ten groups. The classification process is mutually exclusive and all inclusive, which means that every woman fits into one group and one group only 6. Main strengths of the Robson classification are the simplicity of its design, the validity of its purpose, its ease of implementation and directness of initial interpretation 7. The aim of present study was to calculate overall cesarean section rate, to identify groups of women (distributed according to Robson’s ten group classification system) contributed most to overall cesarean section rate and to analyze cesarean section rates within groups in our institute. Material and methods The present study was a cross sectional descriptive study conducted in the department of obstetrics and gynaecology, Kamla Raja Hospital and Gajra Raja Medical College, Gwalior (MP), for a period of 1 year from January 2019 to December 2019. It included all pregnant women with gestational age more than 28 weeks, delivered during the study period. Data was collected from hospital records. Details of study participants like parity, gestational age at delivery, onset of labor (spontaneous or induced), presentation of fetus (cephalic, breech or any other), singleton or multiple pregnancy, previous delivery details like mode of delivery, were collected. All women were classified according to “Robson’s ten group classification system” as follows 81. Nulliparous women with a single cephalic pregnancy, > 37 weeks gestation in spontaneous labour. 2. Nulliparous women with a single cephalic pregnancy, > 37 weeks gestation who either had labor induced or were delivered by cesarean section before labour. 3. Multiparous women without a previous uterine scar, with a single cephalic pregnancy, > 37 weeks gestation in spontaneous labour. 4. Multiparous women without a previous uterine scar, with a single cephalic pregnancy, > 37 weeks gestation who either had labor induced or were delivered by cesarean section before labour. 5. All multiparous women with at least one previous uterine scar, with a single cephalic pregnancy, > 37 weeks gestation. 6. All nulliparous women with a single breech pregnancy. 7. All multiparous women with a single breech pregnancy, including women with previous uterine scars. 8. All women with multiple pregnancies, including women with previous uterine scars. 9. All women with a single pregnancy with a transverse or oblique lie, including women with previous uterine scars. 10. All women with a single cephalic pregnancy, < 37 weeks gestation including women with previous uterine scars. Following definitions were used for core variables Nullipara: a women who had not delivered an infant weighing > 1kg or at gestational age > 28 weeks, ali (...truncated)