Abstract
Background Primary cesarean birth rates were high among women who were either nulliparous (Group 2) or multiparous (Group 4) with a single, cephalic, term fetus who were induced, augmented, or underwent cesarean birth before labor in our study cohort. Objectives The objective of this analysis was to determine what risk factors were associated with cesarean birth among Robson Groups 2 and 4. Methods This study was a prospective hospital-based cross-sectional analysis of a convenience sample of 1,000 women who delivered at Mizan-Tepi University Teaching Hospital in the summer and fall of 2019. Results Women in Robson Groups 2 and 4 comprised 11.4% (n = 113) of the total population (n = 993). The cesarean birth rate in Robson Group 2 (n = 56) was 37.5% and in Robson Group 4 (n = 57) was 24.6%. In Robson Group 2, of all prelabor cesareans (n = 5), one birth was elective cesarean by maternal request; the intrapartum cesarean births (n = 16) mostly had a maternal or fetal indication (93.8%), with one birth (6.2%) indicated by “failed induction or augmentation,” which was a combined indication. In Robson Group 4, all 4 women delivered by prelabor cesarean had a maternal indication (one was missing data), and 3 of the intrapartum cesareans were indicated by “failed induction or augmentation.” In multivariable modeling of Robson Group 2, having a labor duration of “not applicable” increased the risk of cesarean delivery (RR 2.9, CI (1.5, 5.4)). The odds of requiring maternal antibiotics was the only notable outcome with increased risk (RR 11.1, CI (1.9, 64.9)). In multivariable modeling of Robson Group 4, having a labor longer than 24 hours trended towards a significant association with cesarean (RR 3.6, CI (0.9, 14.3)), and women had a more dilated cervix on admission trended toward having a lower odds of cesarean (RR 0.8, CI (0.6, 1.0)). Conclusion Though rates of primary cesarean birth among women who have a term, single, cephalic fetus and are induced, augmented, or undergone prelabor cesarean birth are high, those that occur intrapartum seem to be associated with appropriate risk factors and indications, though we cannot say this definitely as we did not perform an audit. More research is needed on the prelabor subgroup as a separate entity.
Highlights
Introduction e World HealthOrganization recommends applying the Robson classification for cesarean birth to birth cohorts to better understand which of ten mutually exclusive subgroups are contributing to cesarean birth rates [1, 2]
When we applied the Robson classification to a convenience sample of women undergoing cesarean birth at our study site, we found that cesarean birth rates were relatively low in these subgroups (19.4% and 16.1%, respectively, though they accounted for the most cesarean births at the site) [4,5,6,7]
When the Robson classification was applied to the 993 women, 113 (11.4%) of them were qualified as being in Robson Groups 2 and 4
Summary
Introduction e World HealthOrganization recommends applying the Robson classification for cesarean birth to birth cohorts to better understand which of ten mutually exclusive subgroups are contributing to cesarean birth rates [1, 2]. We noted that in nulliparous (Group 2) and multiparous (Group 4) women with single, cephalic, term fetuses who required induction, augmentation, or had a cesarean birth prelabor, the cesarean birth rates were very high—37.5% in Group 2 and 24.6% in Group 4 As these groups account for potentially preventable. Primary cesarean birth rates were high among women who were either nulliparous (Group 2) or multiparous (Group 4) with a single, cephalic, term fetus who were induced, augmented, or underwent cesarean birth before labor in our study cohort. Ough rates of primary cesarean birth among women who have a term, single, cephalic fetus and are induced, augmented, or undergone prelabor cesarean birth are high, those that occur intrapartum seem to be associated with appropriate risk factors and indications, though we cannot say this definitely as we did not perform an audit. More research is needed on the prelabor subgroup as a separate entity
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
