Analysis of Caesarean section rate dynamics at Riga Maternity hospital between 2011 and 2015 according to Robson Ten Group Classification System

Abstract

Introduction: The overall trend of increase in CS rate without clear evidence of decreases in maternal or neonatal morbidity or mortality raises significant concern that CS is overused. In 2001, Robson presented Ten Group Classification System (TGCS), which stratifies women according to their obstetric characteristics and in 2011 WHO stated that Robson would be the best to fulfill current international and local needs. In Latvia until now indication and urgency, based classifications were used. This is the first analysis of CS using TGCS. Aim. The purpose of the study was to carried out the audit of CS rate at Riga Maternity hospital using TGCS, and to see the dynamics of overall CS rate, the rate in each Robson group, and the contribution of each group to the overall CS rate, as well as to identify main indications for CS in the groups with major impact. Materials and methods: A descriptive retrospective study was conducted for 5 years from 2011 to 2015 at Riga Maternity hospital. Data were analyzed using TGCS, which stratifies all deliveries into 10 groups based on five routinely collected obstetric characteristics – parity, onset of labor, gestational age, fetal presentation, and number of fetuses. Statistical analysis and graphics were made by Matlab program. Results: A total 33,064 women gave birth from 2011 to 2015. Groups 1 (nulliparous with single cephalic full-term pregnancy with spontaneous labor), group 2 (nulliparous with single cephalic full-term pregnancy with induced labor (group 2a) or CS before labour (group 2b)), and group 3 (multiparous with single cephalic full-term pregnancy with spontaneous labor) are the largest groups representing in this study (Fig. 1A). Overall CS rate was decreasing from 2011 to 2014 (24.4%, 20.0%, 22.2% 19.9% respectively), and increased again in 2015–23.2% (Fig. 1B). Group 1 and 2 and group 5 (multiparous with previous caesarean section single cephalic full-term pregnancy) made the largest contribution to the overall CS rate. The main indications for CS are fetal distress, dystocia and cephalopelvic disproportion in group 1 and 2. In group 5 the main indication is previous CS. Comparing 2015 vs.2011, the largest increase in absolute contribution to the overall caesarean section rate are recorded in group 10 (women with single cephalic pre-term pregnancy) (+0.32%), group 5 (+0.21%), and group 1 (+0.19%), Fig. 1D. Although the CS rate has decreased within the group 5 (−5%), Fig. 1C, the size of the group 5 increased and also the contribution of this group to overall CS rate, Fig. 1D. Conclusion: Group 1, 2 and 5 are the largest contributors to the overall CS rate at Riga Maternity Hospital. To reduce the overall CS rate it is necessary to reduce CS rate in nulliparous women with single cephalic full-term pregnancy and increase vaginal birth after the first CS. A comparative analysis using the TGCS should be carried out in all institutions for childbirth in Latvian every year.