The Rates of Cesarean Section Deliveries According to Robson Classification System During the Year of 2018 Among Patients in King Abdul-Aziz Medical City, Jeddah, Saudi Arabia.

Shaymaa M Alsulami,Hatim M Al-Jifree,Israa A Malli,Rafeef O Jarwan,Suheal K Albar,Mohammed T Ashmawi

doi:10.7759/cureus.11529

Abstract

Background: The rate of cesarean section (CS) births has been rapidly increasing in Saudi Arabia during the last two decades. Using the Robson Ten Group Classification System (TGCS) to classify and analyze the causes of the high CS rate.Objective: To assess the increasing rates of CS by the implementation of the Robson TGCS on all CS births in our chosen population.Study design: An observational, cross-sectional study conducted among all deliveries at the King Abdul-Aziz Medical City (KAMC), Jeddah, Saudi Arabia during most of 2018. Over the study period, 3168 births were enrolled in the study.Results: The analysis of 3168 births, where 870 women gave birth through CS, resulted in a CS rate of 27.5%. The three major TGCS which contributed to the CS rate were group 5, 2 (divided into 2A and 2B), and 3. Class 5 (Previous CS, single cephalic, ≥37 weeks) contributed the most to the CS rate by 36.5%. Followed by Class 2 (divided into 2A; nulliparous, singleton, cephalic, ≥37 weeks, induced labor and 2B; nulliparous, singleton, ≥37, pre-labor CS) which contributed by 12.9%. Class 3 (multiparous (no previous CS), singleton, ≥37 weeks, spontaneous labor) was the third-highest contributing group by 9.2%. Women who gave birth spontaneously and vaginally were 1403 (44.3%) where women whose labor was induced were 1286 (40.6%).Conclusion: The CS rate in KAMC was 27.5%. After classifying these patients according to the TGCS, Class 5 had the largest percentage of patients going for CS (36.2%). While they are individually low together, Robson classes from Class 1 to 4 (which are considered as low-risk classes) were responsible for 37.8% of the patients going for CS. Since the previously mentioned groups are considered low-risk they should be targeted by health institutions to reduce the CS rate. Improved education of nulliparous and multiparous women who never underwent a CS to prevent nonmedically indicated CS is in order, to preclude repeated CS births in the future and further increase the CS rate.

Highlights

Cesarean section (CS) is a surgical procedure where the mother’s abdomen and uterus are incised to deliver one fetus or more [1]
The three major Ten Group Classification System (TGCS) which contributed to the cesarean section (CS) rate were group 5, 2, and 3
Patients with normal placentation were 3147 (99.3%), and patients who presented with placenta previa or accreta were nine patients (0.7%)

Summary

Introduction

Cesarean section (CS) is a surgical procedure where the mother’s abdomen and uterus are incised to deliver one fetus or more [1]. CS has a higher rate of maternal and fetal complications compared to vaginal deliveries [3]. Some of these complications cause a higher risk of abdominal organs injury, various infections, placenta previa, placenta accrete, and neonatal respiratory problems [3]. The CS rate is rapidly increasing, both globally and locally in the previous two decades, evoking worldwide concerns [5]. CS can effectively avert maternal and perinatal morbidity and mortality rates when medically justified. The rate of cesarean section (CS) births has been rapidly increasing in Saudi Arabia during the last two decades. Using the Robson Ten Group Classification System (TGCS) to classify and analyze the causes of the high CS rate

Methods

Results

Discussion

Conclusion