Robson Classification System Research Articles

What is an Ideal Cesarean Birth Rate? The Use of the C-Model and the Further Interpretation with the Robson Classification System, A Retrospective Analysis

What is an Ideal Cesarean Birth Rate? The Use of the C-Model and the Further Interpretation with the Robson Classification System, A Retrospective Analysis

CESAREAN AUDIT: USING ROBSON’S 10 GROUP CLASSIFICATION AT C. U. SHAH MEDICAL COLLEGE AND HOSPITAL

Objective: The World Health Organization (WHO) has expressed concern over the rising cesarean section (CS) rate, particularly in middle-and high- income countries. The reasons behind this increase are still debated, but the WHO declared that there is no justification for a rate higher than 10–15%. The Robson classification system, advocated by WHO and FIGO, can help assess and compare CS rates. Study Design and Methods: The Gynecology Department at C.U. Shah Medical College and Hospital conducted an observational study on pregnant patients hospitalized for labor pain between January 2020 and December 2022, with a focus on CS patients. The study used Robson’s 10-group categorization technique to extract maternal features and categorize cesarean performances. Results: Between January 2020 and December 2022, C. U. Shah Medical College and Hospital delivered 4967 patients, of whom 1,572 underwent a CS section. 46.3% were nulliparous, and 53.7% were multipara. 78.31% of patients arrived at full term, with 98.8% having single conceptions. 94.8% of the cases had a cephalic presentation, 4.4% had a breech presentation, and 0.81% had a transverse position. Conclusions: Robson classification is a useful technique for analyzing cesarean delivery (CS) rates, aiding in identifying corrective methods to reduce burden on healthcare systems, and promoting accurate labor monitoring, fetal scalp electrodes, and prenatal education.

How two-child policy affects cesarean section in women with advanced maternal age (AMA): using the Robson classification system

ObjectivesTo study the possible associations between advanced maternal age and cesarean section(CS) under the two child policy.MethodsThis study used a cohort study from Dongguan People’s Hospital in Guangdong Province, China from 2017 to 2020. The cohort was restricted to women aged ≥ 20 who give birth to babies with a gestational age of > 28 weeks and a weight of > 1000 g. Divide the advanced maternal age (AMA) pregnant women into two age groups: 35–39 years old and 40 years old or older age. We analyzed CS rate and CS contribution using the modified Robson classification system. Frequency of cesarean was determined for each group and compared by using χ2 and prevalence ratio.ResultsOverall, 47654 women were included, of which 7924 (16.63%) were between the ages of 35 and 39, and 1529 (3.21%) were aged 40 or older. The total CS rate is 40.64%, with 36.10% for mothers aged 20 to 34, 57.90% for women aged 35 to 40, and 64.75% for women aged 40 or older age. In the AMA groups (n = 9453), Robson group 2’ was the most common, followed by groups 5 and 10. Women at 40 years or older age were 3 times more likely to undergo a cesarean delivery in Robson group 1’, and 1.76 times more likely in group 10. The CS rate in group 2’ were statistically significantly higher in the very AMA group.ConclusionsThe CS rates increased noticeably with maternal age under the two child policy. Based on the modified Robson classification system, AMA women should pay more attention to primiparous women with single pregnancy, uterine scars, and premature birth in multiple pregnancies.

Cesarean section in postdated pregnancies: Evidence from a hospital-based cross-sectional study in Bangladesh

Background: Postdated pregnancies pose maternal and fetal risks, often leading to increased rates of cesarean section (CS). Cesarean sections are performed without medical necessity in some cases, thereby increasing both risks and healthcare costs. The study aimed to assess the indications and fetomaternal outcomes of CS in postdated pregnancies. Methodology: This cross-sectional study was carried out at a specialized hospital in Dhaka. It analyzed 59 postdated pregnancies undergoing cesarean section from May to December 2020. Fetomaternal characteristics and outcomes were descriptively analyzed, and cases were also categorized using the Robson Classification and analyzed descriptively to understand cesarean section rates among different obstetric groups and to identify intervention areas. Results: Most women were 20–30 years old (72.9%), with 22% exceeding 42 weeks gestation. 72% of postdated primigravida had CS, comprising 64.4% of all cases. Half of the women received antenatal care (ANC) irregularly. Maternal outcomes were mostly uneventful (83%); while 17% experienced postpartum hemorrhage. Of the babies, 15.3% had low birth weight (<2.5 kg), and 23.7% had low APGAR scores at 1 minute. Major CS indications included fetal distress (67.8%), failed induction (16.9%), and failure to labour progress (15.3%). The Robson Classification system found Group 2 accounted for 64% of all CSs. Higher cesarean section rates were also observed within various groups, particularly in Groups 5 and 6. Conclusion: This study found a higher cesarean section rate among postdated primigravida, with fetal distress being the most common indication. Using the Robson classification could reduce unnecessary cesarean deliveries in this group.

Evaluation of cesarean delivery rates and factors associated with cesarean delivery among women enrolled in a pregnancy cohort study at two tertiary hospitals in Thailand.

Cesarean delivery rates have increased globally resulting in a public health concern. We estimate rates of cesarean deliveries among Thai women using the World Health Organization(WHO) Robson Classification system and compare rates by Robson group to the Robson guideline for acceptable rates to identify groups that might benefit most from interventions for rate reduction. In 2017 and 2018, we established cohorts of pregnant women aged ≥ 18 years seeking prenatal care at two tertiary Thai hospitals and followed them until 6-8 weeks postpartum. Three in-person interviews (enrollment, end of pregnancy, and postpartum) were conducted using structured questionnaires to obtain demographic characteristics, health history, and delivery information. Cesarean delivery indication was classified based on core obstetric variables (parity, previous cesarean delivery, number of fetuses, fetal presentation, gestational week, and onset of labor) assigned to 10 groups according to the Robson Classification. Logistic regression was used to identify factors associated with cesarean delivery among nulliparous women with singleton,cephalic, term pregnancies. Of 2,137 participants, 970 (45%) had cesarean deliveries. The median maternal age at delivery was 29 years (interquartile range, 25-35); 271 (13%) participants had existing medical conditions; and 446 (21%) had pregnancy complications. The cesarean delivery rate varied by Robson group. Multiparous women with > 1 previous uterine scar, with a single cephalic pregnancy, ≥ 37 weeks gestation (group 5) contributed the most (14%) to the overall cesarean rate, whereas those with a single pregnancy with a transverse or oblique lie, including women with previous uterine scars (group 9) contributed the least (< 1%). Factors independently associated with cesarean delivery included age ≥ 25 years, pre-pregnancy obesity, new/worsen medical condition during pregnancy, fetal distress, abnormal labor, infant size for gestational age ≥ 50th percentiles, and self-pay for delivery fees. Women with existing blood conditions were less likely to have cesarean delivery. Almost one in two pregnancies among women in our cohorts resulted in cesarean deliveries. Compared to WHO guidelines, cesarean delivery rates were elevated in selected Robson groups indicating that tailored interventions to minimize non-clinically indicated cesarean delivery for specific groups of pregnancies may be warranted.

Analysis of caesarean section through Robson classification system: An emerging concept to audit the increasing caesarean section rate

Analysis of caesarean section through Robson classification system: An emerging concept to audit the increasing caesarean section rate

Optimizing caesarean section use and feasibility of implementing the Robson classification system: Perspectives of healthcare providers and policymakers.

In recent decades, caesarean section rates have increased dramatically worldwide and the reasons for this trend are not fully understood. This continuing trend has raised public health concerns regarding higher maternal and perinatal risks, high costs, healthcare efficiency, and inequality of services. The current study aimed to explore the perspectives and insights of healthcare providers and policymakers in the Israeli health system regarding the factors that drive caesarean section rates and the readiness and feasibility of implementing the Robson Ten Group Classification System for the first time. Semi-structured interviews were conducted (n = 12) with purposefully selected healthcare providers and policymakers in Israel. Data was analysed inductively using a thematic analysis approach. The findings reflected the "changing landscape" in childbirth practices and attitudes that contributes to the rising caesarean section rate, including childbirth at older ages, birth planning, and a transition toward a more collaborative decision-making approach to childbirth. The participants emphasized the lack of a standardized classification or consistent data monitoring of caesarean section in the Israeli health system. Additionally, enablers to implement the Robson Ten Group Classification System in Israel (ease of use, data collection and recording, and the allocation of resources and personnel), as well as barriers (concerns over workload, limited resources, budget implications, and technological complexity), were found. This study revealed the multifaceted factors shaping caesarean section rates within Israel and underscored the perceived need for evidence-based monitoring and informed decision-making in healthcare practices. Our findings support the conclusion that empirical evidence and clear data are crucial for effective caesarean section use and are currently lacking in Israeli hospitals. Thus, it is recommended to adopt a globally standardized, accepted, and effective tool-the Robson Ten Group Classification System-to accommodate the "changing landscape" in alignment with evolving medical and societal dynamics, which consequently will assist in optimizing caesarean section use.

Robson Classification System: An Essential Tool for Evaluating Caesarean Section Indications and Implications at LUMHS

Background: The rise in the number of caesarean section (CS) deliveries worldwide has raised questions about its suitability and effects on the health outcomes of mothers and newborns. Consequently, healthcare professionals have been exploring standardized approaches for assessing the necessity of CS procedures to promote efficient use of this surgical intervention. The Robson Classification System has become a beneficial resource for classifying CS indications and supporting efforts to enhance the quality of obstetric care. Objective: To evaluate the utility of the Robson Classification System in assessing caesarean section indications and its implications at LUMHS. Study Design: Cross-sectional study. Settings: This study was done at Gynae and OBS department of Liaquat University of Medical &amp; Health Sciences (LUMHS), Jamshoro Pakistan. Duration: Three-month period from November 2020 to February 2021. Methods: Women who underwent CS deliveries with available data necessary for categorizing them into the ten groups of the Robson Classification System were included. After undergoing cesarean sections, patients were screened to classify them according to the Robson 10-group system. The information obtained was strictly used for the study's objectives and treated with confidentiality. Subsequently, the collected data were inputted into SPSS version 26 for analysis. Results: The overall rate of CS was 51.2%. Mean age of the patients was 36.73+2.43 years. The highest contributors to the CS rate were in women with preterm singleton cephalic term pregnancies (group 10) 31.7% and multiparous; single term pregnancy with one and more previous caesarean section around 5 a and b) 31.9%, followed by nulliparous, single, cephalic, ≥37 weeks, spontaneous labor (group 1) 11.2%, (group 2b) 8.1%, (group 3) 5.7% and (group 4) 4.0%. Conclusion: The CS rate was observed to the highly frequent, with Robson groups 5 and 10 being the primary drivers of this heightened rate. Initiatives aimed at decreasing the initial CS occurrence by enhancing the management of both spontaneous and induced labors, as well as strengthening clinical protocols to promote vaginal birth after CS, are anticipated to yield the most substantial impact on reducing the CS rate.

Strengthening Competence of Hospital Data Management to Control The Quality Of Cesarean Section Rate in Banten Province, Indonesia

Cesarean delivery dramatically increased worldwide, including in Indonesia, especially after the implementation of National Health Insurance, with a steady increase of 2-3% every year. This study aims to evaluate the effect of guidance in implementing the Robson Classification in cesarean section quality control in hospitals. Three hospitals in Banten were enrolled in this study: one public hospital and two private hospitals. Each hospital’s staff were given online and offline training on quality control of cesarean section, managing cesarean section data, data entry, data analysis and presentation using Robson Classification. Participant’s knowledge and attitude were collected before and after intervention using a standardized questionnaire. The results showed that the intervention improved many aspects of the workflow and knowledge of the hospital staff regarding cesarean section. There was an increase of up to 77.7% in digital data management, a 23.6% increase in routine meeting activities, and a 29.5% increase in cesarean quality control. The Robson classification system was implemented successfully, increasing the staff's ability to identify the groups needing cesarean sections more effectively. Guidance on data management for cesarean section increases the ability of the three hospitals in Banten to control cesarean section using Robson's Classification. Guidance methods can be used to assist other hospitals in controlling cesarean section.

Episiotomy rates in Greek population using the Robson classification system

Episiotomy rates in Greek population using the Robson classification system

Study of Caesarean Section Births in a Tertiary Care Hospital in Mumbai Using Robson Classification System.

Robson ten-group classification system is recommended by WHO (World health organization) as a global standard for assessment and monitoring caesarean section (CS) rates. This classification is simple and robust. It is prospective, easily reproducible and clinically relevant. We conducted a prospective observational study of CS births at a tertiary care institute. Caesarean births in a tertiary care hospital were classified using Robson classification system as recommended by WHO. The study was conducted for period of 6months duration. The ethics committee of the institute approved this study. We enrolled 4771 consecutive women who delivered during this study period. We included patients who had vaginal delivery as well as those who had delivery by CS. Both live births and stillbirths (of at least 500-g birth weight or at least 22weeks gestation (according to WHO recommendations) were included in this study. During this study period, we had 4771 deliveries, out of which 2231 pregnant women (46.76%) were delivered by CS as compared to 2540 vaginal deliveries. Women with previous CS (term with single cephalic pregnancy) were included in Robson group 5. Group 5 had the highest CS rate (13.41%). Robson group 5, 1 and 10 were the largest contributors to the high CS rates at our institute. In our study, 4771 deliveries were conducted during this study period (6months). Out of 4771 deliveries, CS was done in 2231 pregnant women (46.76%). 2540 women had vaginal deliveries. Group 5 (13.41%) which comprised of women with previous CS had the highest CS rate followed by group 1 and group 10. The second largest contribution was from Group 1 with CS rate of 9.01%. Robson Group 1 included nulliparous term women with single cephalic pregnancy in spontaneous labour. Group 10 was the third largest contributor to the overall CS. Group 10 included women who delivered preterm (single cephalic presentation). Group 10 contributed to 8.09% of overall CS rate. We should make every effort to provide CS for women requiring this procedure, rather than work towards achieving a specific rate for CS.

Cesarean section rates in Turkey 2018-2023: Overview of national data by using Robson ten group classification system.

Cesarean section (CS) rates continue to rise globally because of various factors. Medically unnecessary cesarean operations have no benefit to the mother or child's health. Since the World Health Organization (WHO) has determined that the acceptable CS rate should not be more than 10-15%, it also stated the use of a classification system to compare different patient groups and facilities. Turkey has the highest CS rates globally and has been rising over the years. This study aims to assess CS rates between 2018 and 2023 using National Health Data and to analyze them according to the Robson classification system and WHO reference values to discuss possible measures against increasing rates. In this study, we assessed the rates of CSs between 2018 and 2023; the CS rate including all 5-years and analysis of CS rates for each Robson group as advocated by WHO. Also, another assessment was done of the facilities where the CSs were applied (Public, private, or university hospitals). The total number of births recorded between 2018 and2023 was 6.161.976. The overall CS rate was 57.55%. The number of total CS operations was 3.546.049. The primary CS rate was 28.83% (N:1.776.503). Significant differences were observed between the public and private centers for each Robson group. The CS rates of Groups 1-4 are obviously higher than expected. The CSs of these groups cumulatively affect the rates of other groups. Nulliparous women have CSs mostly in private hospitals. There is a need for improvements in the health system in this regard for better maternal and child health.

Analysis of Cesarean Section Rates in a Public Tertiary Hospital During Teaching and Non-teaching Periods Using the Robson Ten Group Classification System.

The rising cesarean section (CS) rate is a global concern. One of the hospital characteristics that may explain the variation in CS among hospitals is hospital teaching status. This study aims to assess the rate of CS in a tertiary hospital during the teaching and non-teaching periods and to conduct an analysis using the Robson ten-group classification system. This study is a retrospective cohort that assessed pregnant mothers who gave birth at a tertiary hospital in Bandar Abbas. The study population was divided into two groups: those who gave birth during the hospital's teaching period (November 1st, 2019 to October 30th, 2020) and those who gave birth after that (November 1st, 2020 to October 30th, 2021). The primary outcome was the rate of CS according to Robson's classification system. The secondary outcome was the contributions of each group of Robson to the overall CS rate. Data were extracted by trained collectors from the "Iranian Maternal and Neonatal Network (IMaN Net)," a valid national system, using electronic patient records. Of the total number of births (8382), 62.9 % occurred during the teaching period and 37.1 % during the non-teaching period. A 7% increase in CS was observed during the teaching period of the hospital compared to the non-teaching period (p<0.01). CS rate in Robson groups 1,2,4,7, and 10 differs significantly between teaching and non-teaching periods. According to the findings, Groups 5, 10, and 2 were the three most significant contributors to overall CS in our hospital during the study period. The efforts to reduce the overall CS rate should be focused on groups 2,5, and 10 of Robson.

Cesarean sections and early-term births according to Robson classification: a population-based study with more than 17 million births in Brazil

BackgroundCesarean section (CS) rates are increasing worldwide and are associated with negative maternal and child health outcomes when performed without medical indication. However, there is still limited knowledge about the association between high CS rates and early-term births. This study explored the association between CSs and early-term births according to the Robson classification.MethodsA population-based, cross-sectional study was performed with routine registration data of live births in Brazil between 2012 and 2019. We used the Robson classification system to compare groups with expected high and low CS rates. We used propensity scores to compare CSs to vaginal deliveries (1:1) and estimated associations with early-term births using logistic regression.ResultsA total of 17,081,685 live births were included. Births via CS had higher odds of early-term birth (OR 1.32; 95% CI 1.32–1.32) compared to vaginal deliveries. Births by CS to women in Group 2 (OR 1.50; 95% CI 1.49–1.51) and 4 (OR 1.57; 95% CI 1.56–1.58) showed the highest odds of early-term birth, compared to vaginal deliveries. Increased odds of an early-term birth were also observed among births by CS to women in Group 3 (OR 1.30, 95% CI 1.29–1.31), compared to vaginal deliveries. In addition, live births by CS to women with a previous CS (Group 5 - OR 1.36, 95% CI 1.35–1.37), a single breech pregnancy (Group 6 - OR 1.16; 95% CI 1.11–1.21, and Group 7 - OR 1.19; 95% CI 1.16–1.23), and multiple pregnancies (Group 8 - OR 1.46; 95% CI 1.40–1.52) had high odds of an early-term birth, compared to live births by vaginal delivery.ConclusionsCSs were associated with increased odds of early-term births. The highest odds of early-term birth were observed among those births by CS in Robson Groups 2 and 4.

Can the Day of the Week and the Time of Birth Predict the Mode of Delivery According to Robson Classification?

Worldwide, the cesarean section rate has steadily increased from 6.7% in 1990 to 21.1% in 2018 and is expected to rise even more. The World Health Organization propose the adoption of the Robson classification system as a global standard for monitoring, evaluating, and comparing delivery rates. The purpose of the current study is to use the Robson classification system to investigate how, independently of medical factors, the day of the week and time of delivery may be related to the mode of birth. In the sample analysis, we included the records of 8572 women giving birth in one private health facility in Greece. Over 60% of deliveries during the study period were performed by cesarean section, 30.6% by vaginal delivery, and 8.5% of deliveries were performed by operative vaginal delivery. The results of this study indicate that the lowest birth rates are observed on Monday, Saturday, and Sunday. Nulliparous women with no previous cesarean delivery, with a singleton in cephalic presentation ≥37 weeks with spontaneous labor (group 1) are 73% more likely to deliver by cesarean section between 08:00 A.M. and 03:59 P.M. compared to those who give birth between 12:00 A.M. and 07:59 A.M. Also, multiparous women with a single cephalic term pregnancy and one previous cesarean section (group 5.1) are 16.7 times more likely to deliver by cesarean section in the morning compared to overnight deliveries. These results point out two non-clinical variables that influences the CS rate. The Robson classification system was a useful tool for the above comparisons.

Variables associated with the Robson Ten-Group Classification System in the State of São Paulo, Brazil

This study evaluated the associations between the groups of the Robson Classification System and maternal sociodemographic characteristics among neonates in São Paulo State, Brazil, 2016. The groups 5, 6, 7, 8 and 9 tend to be associated to cesarean delivery and more privileged educational opportunities, while the groups 1, 4 and 3 tend to be associated to vaginal delivery and less privileged educational opportunities. These results reinforce the notion that strategies for reduction of cesarean deliveries should go beyond a biomedical model focused on biological factors, and should also consider the social factors that characterize the living conditions of people.

Analysis of Cesarean Section Rates Based on ROBSON Classification System in a Tertiary Care Hospital in West Coast of Gujarat, India

Background with objectives: Because of growing concern over the increasing C-Section worldwide, WHO proposes the ROBSON classification system as a global standard for assessing, monitoring and comparing caesarean section rates. Objective of present study is to investigate CS rates according to ROBSON classification system and to determine area of concern to decrease overall C-section rates. Methods: This study is a retrospective descriptive cohort study done with all caesarean sections delivered in a tertiary teaching hospital in the west coast of Gujarat, India from January 2022 to December 2022. Results: In current study, total CS rate was 28.47%. The major contributor to total CS rate was ROBSON I group (34.09%) followed by ROBSON V (26.34%). Major indications for ROBSON I group include fetal distress due to meconium-stained liquor (25%), Cephalo-pelvic disproportion (CPD) stage1(18%). Major indications for ROBSON group V includes CPD 1(31%), scar tendereness(23%) and previous 2 LSCS(14%). Conclusion: ROBSON I and V being major contributors to total CS suggest to focus on these groups to reduce total CS rate. Art of proper labor monitoring is to be rejuvenated to reduce ROBSON I group, more trial of labor after cesarean should be performed to reduce ROBSON V group.

Robson classification of caesarean births: implications for reducing caesarean section rate in a private tertiary hospital in Nigeria

BackgroundCaesarean section (CS) is a potentially lifesaving obstetric procedure. However, there are concerns about the rising CS rate in many countries of the world including Nigeria. The Ten-Group Robson classification system is presently recommended as an effective monitoring tool for comparing CS rates and identifying target groups for intervention aimed at reducing the rates. The aim of this study was to evaluate the cesarean section rate and the groups with the highest risk of CS at the obstetric unit of Babcock University Teaching Hospital (BUTH), using the Robson classification system.MethodsA cross-sectional study involving 447 women who gave birth at the obstetric unit of BUTH between August 2020 and February 2022. Relevant information was retrieved from the delivery records of the study participants. Data were analyzed using the IBM-SPSS Statistics for Windows version 23.0 (IBM Corp., Armonk, NY, USA).ResultsThe overall CS rate was 51.2%. Multiparous women with previous CS, single, cephalic, term (group 5); nulliparous women, single cephalic, term, with induced labour or pre-labour CS (group 2); women with preterm single cephalic, term (group 10); and single cephalic term multiparous women in spontaneous labour (group 3) were the largest contributors to CS rate accounting for 34.5%, 14.0%, 12.6%, and 10.0% respectively. The commonest indication for CS was previous CS (87; 38.0%), followed by poor progress in labour (24; 10.5%).ConclusionsThe CS rate in BUTH is high and Robson groups 5, 2 10 and 3 were the major contributors to this high rate. Interventions directed at reducing the first CS by improving management of spontaneous and induced labours; and strengthening clinical practice around encouraging vaginal birth after CS will have the most significant effect on reducing CS rate.

Analysis of Cesarean Section Rates Using the Robson Classification System in a Training and Research Hospital in Turkey

Analysis of Cesarean Section Rates Using the Robson Classification System in a Training and Research Hospital in Turkey

Implementation of the Robson Classification in Greece: A Retrospective Cross-Sectional Study.

Cesarean sections have become the most commonly performed operations around the world. The World Health Organization recommended the use of the Robson classification system as a universal standard to establish a joint control system in healthcare facilities. The aim of this study was to implement the Robson classification for the first time in Greece to identify trends in cesarean births and examine the groups of women who are the main contributors to the increasing rates. Moreover, the indicators for cesarean sections will be evaluated as per the Robson classification. In the sample analysis, we included the records of 8572 women giving birth in one private health facility in Greece. A total of 8572 women gave birth during the study period, of which 5224 (60.9%) were cesarean section births and 3348 (39.1%) were vaginal births. In our study, according to the Robson classification, the largest contributors to the overall CS rate were as follows: (a) nulliparous women with a single cephalic term pregnancy, who were either labor induced or delivered by cesarean section before labor-Group 2 (34.6%); (b) multiparous women with a single cephalic term pregnancy and at least one previous cesarean section-Group 5 (30.7%); (c) women with a single cephalic preterm pregnancy-Group 10 (11.7%); (d) women with multiple pregnancies-Group 8 (7.0%). Our study is expected to assist policymakers in Greece in planning further interventions for each subgroup of women in order to reduce the overall CS rate and unnecessary CSs.