Cesarean delivery in a tertiary institution of the Republic of Moldova: analysis using the Robson classification

Abstract

BackgroundThe worldwide rise in cesarean section rate is a major public health concern and cause of significant debate. Despite multiple studies showing that higher cesarean rates may be associated with adverse maternal and perinatal outcomes, the number of cesarean births increases continuously. In the Republic of Moldova, the cesarean section has increased from 15.75% in 2012 to 27.42% in 2022, however, the perinatal mortality remains unchanged - constituting 11.6‰. In order to understand the factors that determine the increasing trend of cesarean section and to approach new strategies to reduce unnecessary surgical delivery, a standardized tool is needed to assess and compare cesarean section rates. ObjectiveTo assess changes in cesarean section rates and trends and to evaluate the contribution of different obstetrical populations to overall cesarean rates in Municipal Clinical Hospital using the Robson Classification. Study DesignA cohort study conducted at the Municipal Clinical Hospital in Chisinau. The study includes 13882 women who gave birth in 2017, 2019, and 2022 in this hospital. All births were classified into 10 Robson groups, using six basic variables (parity, cesarean section delivery in medical history, labor onset, number of fetuses, gestational age, and fetal presentation). Statistical data were collected and analyzed using the Epi INFO program. ResultsThe overall cesarean section rate was 20.02% (2779/13882) with a significant increase from 18.59% (809/4351) to 21.59% (1134/5252), P=0.0003. Approximately one-third 39.55% (1099/2279) of all cesarean deliveries were performed before the labor onset. The main contributor in all study years is Group 5 - 34.44% (957/2779). The next valuable group as a contributor to the overall cesarean rate are the women from Group 2 representing 14.14% (393/2779), followed by women of Group 1 with 11.98% (333/2779). ConclusionsThe use of the Robson Ten-groups classification offers a clear and detailed record of the cesarean section trends, and due to its simplicity and exclusivity, it can be implemented in the Republic of Moldova as well. The main contributors to the overall cesarean rate are women with a previous cesarean delivery - Group 5, followed by nulliparous women of Group 2 and Group 1.