Profile of cesarean section during COVID-19 using Robson ten group classification system in a tertiary teaching hospital, Nepal: a cross-sectional study.

’ Cross-sectional Study Profile of cesarean section during COVID-19 using Robson ten group classification system in a tertiary teaching hospital, Nepal: a cross-sectional study Nischal Shrestha, MBBSa,*, Priyanka Regmi, MBBSb, Sneha Shrestha, MBBSc, Kalpana Nyaupane, MBBSd Introduction: Caesarean section is performed when there are pregnancy related complications and vaginal delivery cannot be tried or fails. The effect of pandemic lockdown on the availability as well as accessibility of health services is a global concern. The aim of this study was to find out the caesarean section rate and its indication at a tertiary care hospital during COVID-19 pandemic. Methods: A hospital-based cross-sectional study was conducted among women admitted for delivery in the Department of Obstetrics and Gynecology of a tertiary teaching hospital during the second wave of COVID-19 (1 May 2021–30 July 2021). Convenience sampling technique was applied and 1350 women were categorized into groups using Robson ten group classification system. Group size, group caesarean rate, absolute and relative contribution of each group to overall caesarean rate were calculated. Results: Out of 1350 total deliveries during COVID-19, lower segment caesarean section was done in 446 (33.04%) (30.53–35.55 at 95% Confidence Interval). Major indication for caesarean section was previous caesarean in 185 (41.48%). Most women 202 (45.29%) were from the age group 24–30 years and gestational age between 37 and 42 weeks. Major contributor to the overall caesarean section rate was Robson group 5 (37%). Conclusions: This study showed higher prevalence of caesarean section delivery rate during COVID-19 pandemic than that compared with 2016 national statistics of Nepal. Despite of several challenges brought by the pandemic, pregnant women were still able to access the emergency obstetric care services in the Eastern part of Nepal. However, future studies should focus on exploring the situation in rural areas too. Keywords: caesarean section, Nepal, obstetrics, pregnancy, robson’s classification Introduction HIGHLIGHTS The second wave of 2019 novel coronavirus (COVID-19) due to delta variant began in April 2021 in Nepal[1]. Only 2.62% of Nepal’s total population was vaccinated against COVID-19 till 28 June 2021[2]. Considering greater susceptibility and low protection against infection, lockdown was re-implemented from 29 April 2021 till 1 September 2021 during second wave[1]. Not only providing health services to the pregnant women but also accessing health services was a great challenge during lockdown. There were around 0.5 million births in 2021 in Nepal which is similar to that of previous years[3]. With the continuous efforts from the Government to reduce maternal and child morbidity • The prevalence rate of caesarean section (CS) during COVID-19 pandemic was higher than that of national statistics of Nepal (2016 NDHS) and normal rate recommended by WHO. • There was 0.5 million birth in 2021 in Nepal which is similar to that of previous years. Pandemic had no profound effect in birth rate. • Despite of several challenges brought by the pandemic, pregnant women were still able to access the emergency obstetric care services in the Eastern part of Nepal. However, future studies should focus on exploring the situation in rural areas too. • We should discourage CS upon maternal interest and educate women on utilizing Antenatal checkup services for early detection of pregnancy related complications. a Nobel Medical College Teaching Hospital, Biratnagar, bTribhuwan University Teaching Hospital, Kathmandu, cKathmandu University School of Medical Sciences, Dhulikhel and dNepalgunj Medical College Teaching Hospital, Nepalgunj, Nepal Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article *Corresponding author. Address: Nobel Medical College Teaching Hospital, Biratnagar, Nepal. Tel.: +9779849943448. E-mail address: shresthasnisal@gmail. com (N. Shrestha). Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Annals of Medicine & Surgery (2023) 85:1699–1704 Received 19 October 2022; Accepted 25 March 2023 Published online 11 April 2023 http://dx.doi.org/10.1097/MS9.0000000000000622 and mortality, the CS rate in Nepal increased substantially from 0.90% in 1996 to 10.20% in 2016[4]. One of the global concerns during the COVID pandemic was if the emergency obstetric services like CS was hindered or not. For the monitoring of CS, WHO has validated Robson’s classification or Ten group classification system (TGCS) as a “global standard” tool[5]. There are handful of studies done using TGCS for analyzing rising CS rates in previous years[6,7], but there had been no such study during COVID-19 pandemic. This study aimed to find out the rate of CS at this tertiary level hospital and analyze its indications based on Robson ten group classification system during second wave of COVID-19 pandemic. 1699 Shrestha et al. Annals of Medicine & Surgery (2023) Annals of Medicine & Surgery Methodology A hospital-based cross-sectional study was carried out in the department of obstetrics and gynaecology at a tertiary level hospital over the period of 3 months from 1 May 2021 to 30 July 2021 after taking ethical clearance from the Institutional Review Committee (Reference number: 614/2021) (UIN no. researchregistry8710). This hospital is located in eastern region of Nepal where people from two provinces (1 and 2) take health services including people from India. The hospital has 29 beds allocated for antenatal ward, 15 for labour ward and 15 beds for gynaecology ward. During COVID-19 pandemic, this hospital served as COVID hospital due to which this hospital had a higher flow of patients during the pandemic compared to other health care institutions. For this study, all the pregnant women who delivered at this hospital during second wave of COVID-19 pandemic including COVID positive cases were enroled after taking informed consent. Women delivering on the way to hospital (outside the hospital) and the cases which were referred to another hospital were excluded. This study has been reported in line with the STROCSS criteria[8]. Sample size determination The sample size was determined by 13% prevalence of CS from previous study report[9]. By taking 2% margin of error and at 95% CI, the calculated sample size was 1086. By adding 10% for non-response rate to the calculated sample size, the calculated sample size was 1195. However, sample of 1350 delivery cases was taken for this study. Data collection and analyses The clinical details were recorded (...truncated)