Cesarean Section Rate at Lumbini Zonal Hospital, Nepal: An Analysis Using the Robson Ten Group Classification System

Abstract

Background Caesarean section (CS) rates have increased globally. The World Health Organization (WHO) recommends the use of the TenGroup Robson classification as the global standard for assessing appropriateness of CS. Nepal has higher-than-global average rates of CS requiring further investigation into appropriateness. Aim This study aims to investigate the caesarean section rates at tertiary care center in Nepal and make analysis based on the group-10 classification. Methods A retrospective cross-sectional study was carried out from 2016 April -2017 March in Lumbini Zonal Hospital, Butwal, Rupendehi, Nepal. 3,817 women who birth over a 12-month period were analyzed using this classification. The caesarean rate, its indications were calculated and categorized into groups according to Robson’s 10-group classification. Results Women with previous CS (Group 5) comprise the largest proportion (9.4%) of the overall 26.41% CS rate. The second largest contributor was a singleton nulliparous woman with cephalic presentation at term (6.6% of total 26.41%). Caesarean section rates in single breech pregnancies were very high (>65%). Robson’s Group 5 was the highest contributors to overall CS rate contributing 35% of all C-sections, followed by Group 2 (24%), and Group 1 (13%). Conclusion The ten-group classification helped to identify the main groups of the subjects who contribute the most to the overall caesarean section rate. This study results suggest that women with previous CS are at risk for having another CS delivery in subsequent pregnancies and therefore there is an urgent need for a dedicated vaginal birth after caesarean section (VBAC) clinic to support this such women to ensure CS are only done when indicated. Furthermore, reducing the CS rate for nulliparous i.e. Group 1 and 2 would, in the long-term, also reduce the size of Group 5 in the future.