Evaluation of Caesarean Section Rates Utilising Robson’s Classification System: A Retrospective Observational Study from Eastern India

Original Article Obstetrics and Gynaecology Section DOI: 10.7860/IJNMR/2024/68994.2430 Evaluation of Caesarean Section Rates Utilising Robson’s Classification System: A Retrospective Observational Study from Eastern India VAIBHAV SHIVAJI PATIL1, SOHINI BHATTACHARYA2, SELIM AKHTAR3 ABSTRACT Introduction: The increasing trends in Caesarean Section (CS) globally are undoubtedly alarming. Although the World Health Organisation (WHO) did not specify an ‘optimal’ rate in 2015, it is essential to study caesarean deliveries to understand the causes of the rising rates and prevent unnecessary CS. Robson’s classification system, recommended by the WHO, is the most appropriate tool for this purpose. Aim: To identify groups of women according to Robson’s Tengroup Classification System (TGCS) assess the complications and morbidities of both mothers and neonates, and analyse the indications for caesarean delivery. Materials and Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology at Jalpaiguri District Hospital, Jalpaiguri, West Bengal, India, from April 2021 to March 2022. A total of 350 women who underwent CS were included in the study, The study population was divided into ten groups (1-10) according to Robson’s TGCS. The variables assessed included the age group and gravidity status of the mothers, indications for CS, and maternal and neonatal mortality and morbidity. Data were collected from the operating theatre register, mother and baby bed head tickets, sick neonatal care unit admission registers, and Critical Care Unit (CCU)/High Dependency Unit (HDU) admission registers at one-month intervals. Frequencies and percentages were calculated. Results: Most of the women (120 mothers) belonged to the age group of 20-24 years. Out of the total, 206 mothers (59%) were primigravida, while 144 (41%) were multigravida. A total of 73 mothers (20.9%) fell under Group 2 of Robson’s classification system, followed by Group 1 50 (14,3%) and Group 4 49 (14%). The least number of women were in Group 7 11 (3.1%). Oligohydramnios was the indication for 45 mothers (12.8%). Total 10 mothers required HDU admission, and two required CCU admission postoperatively. There were no maternal deaths and no cases of peripartum hysterectomy. One birth was stillborn, and there were 13 neonatal deaths among 349 live neonates. Conclusion: In present study, authors found that most of the mothers were primigravida and fell under Group 2 of Robson’s classification system. The most common indication for CS was foetal distress, followed by a history of previous CS. Keywords: Caesarean audit, Foetal distress, Maternal morbidity, Neonatal morbidity, Robson’s ten group classification system INTRODUCTION The Caesarean Section (CS) is considered a life saving procedure for maternal and/or foetal indications when any obstetric condition precludes vaginal birth. Despite the increased risk of maternal morbidity due to various complications like postpartum haemorrhage, blood transfusion, hysterectomy, Intensive Care Unit (ICU) admission, sepsis, metabolic dysfunctions, and even maternal death, there has been a progressive increase in caesarean births worldwide over the past few decades, including in both developing and developed countries. Researchers have explained various medical and non medical reasons behind this rising rate [1]. Although the WHO recommended in 1985 that CS rates should not exceed 15% [2], in India, CS rates have nearly doubled in the public sector, rising from 8.5% in 2005 to 17.2% in 2016. In the private sector, this rate surged from 12.3% to 40.9% during the same period, indicating a huge gap between these two sectors [3]. In 2015, the WHO introduced a new policy that superseded the earlier one and did not specify any “optimal” rate. Instead, they recommended that “every effort should be made to provide CSs to women in need, rather than striving to achieve a specific rate” [4]. Indian Journal of Neonatal Medicine and Research. 2024 Oct, Vol-12(4): PO17-PO21 Therefore, it is essential to study the population undergoing CS to understand the extent of preventable caesarean deliveries. Robson’s Ten Group Classification System (TGCS), recommended by the WHO and the International Federation of Gynaecology and Obstetrics (FIGO) in 2015, is the most appropriate classification system used globally for monitoring, comparing, and understanding caesarean delivery rates [5]. Hence, objectives of the present study were to identify the groups of women according to Robson’s ten-group classification that contribute the most and the least to overall CS rates at Jalpaiguri District Hospital, to identify the complications and morbidities of both mothers and neonates associated with each caesarean delivery and to analyse the groups regarding the indications for caesarean delivery so that changes in obstetric practices can be suggested. MATERIALS AND METHODS A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology at Jalpaiguri District Hospital, Jalpaiguri, West Bengal, India, from April 2021 to March 2022. Approval was 17 Vaibhav Shivaji Patil et al., Retrospective Study to Evaluate CS using Robson’s TGCS obtained from the Ethical Committee of North Bengal Medical College, Siliguri, Darjeeling, West Bengal (IEC/NBMC/2020-21/68, Dated 31.03.2021). Inclusion criteria: Authors included 350 women who delivered by CS at Jalpaiguri District Hospital, a secondary care level hospital, during the study period. Mothers who underwent CS on every Monday (24-hour duration) of the week were considered in the sample, adhering to the exclusion criteria. Exclusion criteria: Mothers with a gestational age of <32 weeks and Neonates born with congenital anomalies. Study Procedure For monitoring CS, Robson’s TGCS was endorsed by the WHO in 2015 [Table/Fig-1] [5]. This classification system is primarily based on the present pregnancy status (parity, number of foetuses, foetal presentation, and lie), past obstetric history, gestational age, and the course of labour. Data were collected from the mother’s and baby’s bed head tickets, the Special Newborn Care Unit (SNCU) admission register, and the CCU/HDU admission register at onemonth intervals. Group Description Gravida status and booking status N (%) Primi gravida 206 (58.9) Multi gravida 144 (41.1) Booked 154 (44) Not booked 196 (56) [Table/Fig-2]: Distribution of mothers according to gravid status and health care facility booking status. Robson’s ten-group classification N (%) Group 1 (Nullipara, single, cephalic, term pregnancy, spontaneous labour) 50 (14.3) Group 2 (Nullipara, single, cephalic, term, induced labour or planned CS) 73 (20.9) Group 3 (Multipara without uterine scar, single, cephalic, term, spontaneous labour) 45 (12.9) Group 4 (Multipara without uterine scar, single, cephalic, term, induced labour or planned CS) 49 (14) Group 5 (Multipara with (...truncated)