Analysis of caesarean section rates according to Robson’s classification at the Municipal Clinical Hospital, Republic of Moldova

Abstract

Background and aim. The worldwide rise of caesarean section (CS) is a major public health concern and a cause of significant debate due to potential maternal and perinatal risks, cost issues and inequity in access. In the Republic of Moldova, in recent years, the incidence of CS has increased by 7.7% (from 12.08% in 2007 to 20.5% in 2019); however, perinatal mortality rates haven’t changed (10.3‰ in 2007, and 9.7‰ in 2019). In order to understand the factors that determine the increasing trend of CS and to approach new strategies to reduce unnecessary caesarean sections, a standardized tool is needed to assess and compare CS rates. Methodology. A single-center, cross-section study was conducted in the period of January-December 2019. Data were collected from medical charts of women who gave birth in the Department of Obstetrics and Gynecology of the “Gheorghe Paladi” Municipal Clinical Hospital, Chişinău, and classified using the ten-group classification system according to Robson, to determine the CS rate in each group, the absolute and relative contribution made by each group to the overall caesarean section rate. Results. A total of 4279 deliveries were analyzed, and of these, 836 (19.5%) cases were delivered by caesarean section. The most representative group of our population was Group 3 (42.4%), followed by Group 1 (32.1%) and Group 5 (7.5%). The greatest contributors to the overall CS rate were Group 5 (33.8%), Group 2 (14.7%) and Group 1 (11.4%). There was also a high rate of pre-labor caesarean sections in Group 2, Group 4 and Group 10. Conclusions. The obtained results indicate that the greatest contributor to CS rate are women with previous caesarean section, followed by nulliparous women with full-term, cephalic pregnancy. An important step in reducing the total CS rate is to focus our efforts on decreasing the caesarean section rate in primary patients. We found that the Robson classification is clinically relevant and it is an effective tool for analyzing the caesarean section rate in our population.