Analysis of caesarean sections using Robsons classification system in a tertiary centre at CIHSR, Dimapur, Nagaland, India

ISSN Print – 2454-2334; ISSN Online – 2454-2342 DOI - 10.21276/obgyn.20252024.11.1.26 RESEARCH ARTICLE Analysis of caesarean sections using Robsons classification system in a tertiary centre at CIHSR, Dimapur, Nagaland, India Bendangtoshi Jamir, Kanili Jimo, Rebeki Momin Corresponding author: Dr Bendangtoshi Jamir, Senior Consultant, Department of Obstetrics and Gynaecology, Christian Institute of Health Sciences and Research, Dimapur, Nagaland, India; Email – Distributed under Attribution-Non Commercial – Share Alike 4.0 International (CC BY-NC-SA 4.0) ABSTRACT Objectives: The objectives of the study were to assess the rate of caesarean section rate and analysis the caesarean sections using Robson’s TGCS. Methods: A retrospective cohort study was done at CIHSR, Dimapur, Nagaland using total enumerative sampling technique of all caesarean deliveries from 1st January 2019 to 31st December 2019. Results: Of the total 971 deliveries, 299 had caesarean deliveries which give and overall caesarean rate of 30.79%. Group 5 contributes the maximum number of caesareans (32.44%) followed by group 2 and group 1 contributing 25.75% and 13.04% respectively. Group 3 and group 4 constituted a total of 11.7% of caesarean section in our study. Total breech delivery by caesarean was 25 (7.02%) out of which 21 (84%) were delivered by caesarean section. The rest multiple pregnancy (group 8), abnormal lie (group 9) and preterm (group 10) constitutes 3.01%, 0.67% and 6.35% respectively. Conclusions: In our study, the maximum overall caesarean section rate was contributed by group 5 (32.44%) which was followed by group 2 (25.75%) and group 1(13.04%). So reduction of the primary caesarean sections for primi mothers by following proper induction protocols is needed to reduce the cesarean sections. Keywords: Robson’s TGCS, caesarean section, induction, cesarean rate reduction. Caesarean section (CS) is an important lifesaving procedure for both the mother and the baby in obstetrics practice but it has been observed that there is a rise in caesarean section rate in almost all the centers around the world. Even though it’s a lifesaving procedure, unnecessary caesarean section can lead to increased morbidity and mortality. In addition to the health risk of increase rates of caesarean section, it also puts an additional financial burden, particularly in low and middle class community. The World Health Organization recommends a caesarean section rate of 15% or less 1, 2 to balance the benefits and risks of caesarean section. In spite of recommendation from WHO, caesarean delivery rates have been on the rise in the last few decades around the world, going even upto 50- 60% 3, 4 in some centres. Robson’s Ten Group Classification System (TGCS) is the most accepted appropriate classification globally by different institutions 5, 6. Robson’s Ten Group Classification System (TGCS) proposes a system that classifies women into 10 groups based on their obstetric characteristics such as parity, mode of previous deliveries, caesarean section before labour, gestational age, fetal presentation, no. of fetus, onset of labor, spontaneous or induced labor, abnormal lies and preterm delivery. Although a few of similar studies are reported from India and other countries, not many of them were conducted from North East part of India. CIHSR and Hospital is a tertiary care centre in Nagaland, India and conducts more than 1000 deliveries annually with a significant number of caesarean deliveries, amounting to 37 % and 30% in 2018 and 2019 Received: 28th January 2022, Peer review completed: 14th March 2022, Accepted: 10th August 2022. Jamir B, Jimo K, Momin R. Analysis of caesarean sections using Robsons classification system in a tertiary centre at CIHSR, Dimapur, Nagaland, India. The New Indian Journal of OBGYN. 2024; 11(1): 141 - 45. The New Indian Journal of OBGYN. 2024 (July-December);11(1) respectively. Table 1: Modified Robson’s ten-groups classification The objective of the present study was to classify Group Modified Robson’s ten-groups No of C/S C/S rate the caesarean deliveries in this center and analysis as No classification system (Total-299) (%) per Robson’s TGCS which will help the institution in 1 Nulliparous, singleton, cephalic, ≥37 weeks’ 39 13.04 making decision and policies in regards to reduction in gestation, in spontaneous labour caesarean section rate. 2 Nulliparous, singleton, cephalic, ≥37 weeks’ 77 25.75 gestation, induced labour or caesarean Methodology section before labour The study was a retrospective cohort study at Induced 32 10.70 Caesarean section before labour 45 15.05 CIHSR, Dimapur, Nagaland. The samples were women 3 Multiparous (excluding previous caesarean 17 5.68 who had caesarean section and the total enumerative section), singleton, cephalic, ≥37 weeks’ gestation, in spontaneous labour sampling technique was used. 4 Multiparous without a previous uterine scar, 18 6.02 Inclusion criteria - All women delivered by with singleton, cephalic pregnancy, ≥37 caesarean section during a period of one year from 1st weeks’ gestation, induced or caesarean section before labour January 2019 to 31st December 2019, irrespective of Induced 5 1.67 birth outcome were included in the study. Caesarean section before labour 13 4.35 5 Previous caesarean section, singleton, 97 32.44 Exclusion criteria - Women who had caesarean cephalic, ≥37 weeks’ gestation section outside of CIHSR, normal vaginal deliveries, Spontaneous labour 24 8.03 Induced 1 0.33 and instrumental deliveries were excluded. Incomplete Caesarean section before labour 72 24.08 record or details were also excluded from the study. 6 All nulliparous with a single breech 14 4.68 Data collection - Data collection from Hospital IP Spontaneous labour 3 1.00 Induced 0 0 records maintained in medical record department Caesarean section before labour 11 3.68 (MRD). Data were collected by the principal 7 All multiparous with a single breech 7 2.34 (including previous caesarean section) investigator and co investigator. Completeness of the Spontaneous labour 4 1.34 data were checked by the first author. Induced 0 0 Statistical analysis - Variables based on TGCS are Caesarean section before labour 3 1.00 8 All multiple pregnancies (including previous 9 3.01 entered and analysed in Microsoft Excel. Descriptive caesarean section) statistical analysis was used. Spontaneous labour 1 0.33 Induced 0 0 Result Caesarean section before labour 8 2.67 The total numbers of women delivered over the 9 All women with a single pregnancy in 2 0.67 transverse or oblique lie (including those study period from Jan 2019 to Dec 2019 were 971, out with previous caesarean section) of which cesarean section deliveries were 299 which Spontaneous labour 1 0.33 gives and overall caesarean rate of 30.79 %. Table 1 Induced 0 0 Caesarean section before labour 1 0.33 describes the various groups of modified Robson’s ten 10 All singleton, cephalic, <37 weeks’ gestation 19 (...truncated)