Analysis of cesarean sections using Robsons classification system in a tertiary hospital in New Delhi

Abstract

To analyze cesarean section rates using Robsons 10 group classification system in a tertiary hospital over a period of five years (July 2014-Dec 2018). To analyze the main contributors of cesarean sections based on the ten groups under Robsons classification and to further analyze the main indications of cesareans in the relevant groups. All women with one or more previous cesareans with cephalic presentation (group V) contributed to the maximum number of cesareans, (32.5%), closely followed by group I (22.86%) and group IIA (10.25%). 31.65% of the total cesareans were elective cases, 17.23% were in women with inductions and 51.1% of the cesareans were in spontaneously laboring women.Robsons Ten Group Classification system (TGCS) found to be easy to understand, clear, mutually exclusive, reproducible system for classifying cesareans in all levels of Institutions. Among women who had elective cesareans, maximum were done in those in Group V who were not willing for TOLAC or those who has previous two cesareans. In spontaneously laboring women, 34% were due to meconium stained liquor and 32.9% were due to fetal distress, thus leaving a huge scope for reduction in cesarean rates. All institutions should routinely monitor cesareans based on Robsons TGCS to monitor time trends and for interinstitutional comparisons. Interventions should be targeted at maximizing normal deliveries, reducing primary cesareans and offering TOLAC where possible. There should be institutional protocols for defining indications like fetal distress, nonprogress of labour, failed induction and protocols for their managements.