Abstract
BackgroundSince 1985, the international healthcare community has considered the ideal rate for cesarean section (CS) to be between 10% and 15%.However, CS has been increasing both in developed and developing countries. The aim of the present study was to audit CS using Robson’s Ten Group Classification System (TGCS).MethodologyThis retrospective, hospital record-based study was conducted over a period of three years from April 1, 2016, to March 31, 2019, in the Department of Obstetrics and Gynecology at Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. Data of patients who delivered by CS during this period were recorded and categorized in the 10 groups of TGCS. The size of each group, CS rate, and contribution of each group toward overall CS were calculated. Indications of CS in each group were analyzed, and strategies were planned to optimize the use of CS. The Chi-square test was used to analyse the statistical significance of the differences in the number of CS between the different Robson's groups.ResultsThe total number of deliveries was 2,128 during the study period, of which CS was performed in 812 deliveries, with a CS rate of 38.16% in our institute. Robson’s group 5 (34.97%) was the major contributor to the overall CS rate, followed by group 2 (26.35%), group 1 (15.51%), and group 10 (7.14%). The incidence of primary CS (61.82%) was more than repeat CS (38.17%). Previous CS, fetal distress, failed induction, arrest of labor, and malpresentation were the main indications for CS.ConclusionsRobson’s TGCS serves as an important tool for auditing CS. Indications of CS among major contributors and primary group should be analyzed regularly and uniform and standard protocols should be used. Standardization of indications for CS, regular audits, and definite protocols will help in reducing the CS rate in our hospital.
Highlights
Since 1985, the international healthcare community has considered the ideal rate for cesarean section (CS) to be between 10% and 15% [1]
The total number of deliveries was 2,128 during the study period, of which CS was performed in 812 deliveries, with a CS rate of 38.16% in our institute
Previous CS, fetal distress, failed induction, arrest of labor, and malpresentation were the main indications for CS
Summary
Since 1985, the international healthcare community has considered the ideal rate for cesarean section (CS) to be between 10% and 15% [1]. The incidence of CS has been increasing both in developed and developing countries. Unindicated CS without evidence of concomitant decrease in maternal or neonatal morbidity and mortality should be avoided to minimize its implications in the index or future pregnancies, as well as to reduce the burden of cost on the healthcare system. Immediate and long-term complications of CS include increased risk of maternal morbidity and mortality, postpartum hemorrhage, increased need for blood transfusion, longer hospitalization, postpartum infections, and retained and adherent placenta [3,4]. Since 1985, the international healthcare community has considered the ideal rate for cesarean section (CS) to be between 10% and 15%. CS has been increasing both in developed and developing countries. The aim of the present study was to audit CS using Robson’s Ten Group Classification System (TGCS)
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