Robson Group Research Articles

Analysis of Caesarean Delivery in General Hospitals in Sokoto State Using Robson’s Ten Classification: A Cross-Sectional Study

Maternal mortality is relatively higher in the northern part of Nigeria. The level of caesarean section (CS) performed in a facility in a locality is an important indicator of access to, and quality of maternal health services in that locality. The Robson classification has been recommended by the World Health Organization as a gold standard for assessing, monitoring, and comparing CS rates at all levels. This was a cross-sectional study across six primary health facilities (General hospitals (GHs) spread across six local government areas in Sokoto state, Northwest Nigeria. Data were collected from medical charts of all women who attended antenatal care/delivered from August - November 2022. The overall CS was calculated, and the women categorized into one of the ten Robson groups. The data showed that the women with the highest frequency of delivery were aged less than 20 (44.98%) followed by those aged 20-34. The CS rate in Sokoto State GHs was 13.56%, a rate relatively higher than the average in sub-Saharan Africa. The data showed that the commonest forms of CS were those in Robson’s Group 1-4, which are categorized as low risk forms of CS, where Group 4 had the highest CS cases (26.62%). Our findings can guide the State Ministry of Health in policy formulation and implementation to improve the maternal and child health in the State. Keywords: Caesarean section, delivery, Robson Classification, Obstetrics, Sokoto Nigeria, primary healthcare.

Low Fifth-Minute Apgar Score Analysed According to Robson Ten Group Classification At a Tertiary Hospital in Nigeria

OBJECTIVE: Robson classification can be used to analyze and audit other indices of delivery outcome besides cesarean section (CS). The objective is to analyze low fifth-minute APGAR scores according to Robson’s classification and present deducible conclusions. STUDY DESIGN: A cross-sectional dataset of 584 neonates of parturients at the Federal Medical Centre Yenagoa (FMCY), Bayelsa State, Nigeria between July 2020 and April 2021 was analyzed. Neonates were classified by the corresponding Robson group with subgroup modification of their mothers. Data was analyzed using IBM SPSS Statistics version 25. Descriptive statistics and association between low fifth-minute APGAR Score and the Robson group are presented. The statistical significance is a p value <0.05. RESULTS: The largest contribution (29.6%) to the low fifth-minute APGAR score was from Robson group 3. Group rate was high in groups 10b (66.7%), 7a (61.1%), 10a (53.6%), 9a (50.0%), 6a (50.0%), 5.2a (33.3%) and 10c (30.3%) relative to others. Neonates of parturients in Robson groups 6a (OR - 11.00; 95% CI-1.27-95.18; p Value-0.029), 7a (OR-17.29; 95% CI-3.06-97.52; p value-0.001), 9a (OR-11.00; 95% CI-1.48-81.61; p Value-0.019), 10a (OR-12.69; 95% CI-2.49 - 64.58; p value-0.002) and 10b (OR-22.00; 95% CI-1.33 -362.92; p value-0.031) had significantly higher odds of low fifth minute APGAR score relative to 8c with the lowest group rate. CONCLUSION: Meaningful deduction is possible with use of the Robson’s classification for audit of low APGAR Score. By this study, parturients in Robson groups 3, 5.2a, 6a, 7a, 9a, 10a, 10b, and 10c are identified for focused interventions towards improving APGAR score outcomes at FMCY.

Caesarean section rate reduced by a redesigned birthing room. Results of a quality improvement intervention at a hospital in Democratic Republic of Congo

ObjectiveTo evaluate the influence of a new birthing room at a tertiary hospital in eastern Democratic Republic of Congo (DRC), on the caesarean section (CS) rate in women classified as Robson group 1, i.e., nulliparous women at term with spontaneous onset of labour of one foetus in cephalic presentation. MethodAs part of quality improvement interventions, a new birthing room designed to promote person-centredness was constructed at the labour ward at Panzi General Referral Hospital in DRC. In a quasi-experimental study on women classified as Robson 1, a comparison was performed between the group being cared for in the new birthing room and the group being cared for in the general birthing room. The main outcome measure was CS rate. ResultsIn the new person-centred birthing room, the CS rate was 17.1 % versus 28.4 % in women cared for in the general birthing room (p-value 0.001). There was also a higher presence of accompanying persons (p-value < 0.0001) and less use of synthetic oxytocin for the augmentation of labour (p-value 0.024). No difference in fear and childbirth experience was identified between women in the two rooms. ConclusionThe results demonstrate that it is possible, in a low-income country as the Democratic Republic of Congo, to reduce the CS rate in women classified as Robson 1 by adapting the birthing environment to be more person-centred, without compromising other obstetric and neonatal outcomes.

Towards Optimizing Caesarean Section: Robson Ten Group Analysis of Caesarean Section and It’s Determinants in a Tertiary Hospital in South-South, Nigeria

Background: To optimize caesarean section (CS), Robson classification is useful for audit of CS rates within and across hospitals and regions. Valid conclusions are also possible by analyzing other characteristics of parturients that determine CS rates based on Robson groups. This study aimed to analyzed CS rate and determine the impact of parturients’ age and booking status on delivery by CS based on Robson classification. Subjects and Method: A cross-sectional descriptive study that classified parturients into Robson 10-groups using data from hospital records at the Federal Medical Centre Yenagoa (FMCY) in Bayelsa State, south-south, Nigeria. The dependent variable was mode of delivery. The independent variables were parturients’ age and booking status by Robson group. The study instrument was a predesigned spreadsheet used to collect real-time relevant data on all deliveries from patients’ hospital records. Descriptive statistics were presented using frequencies, percentages, mean and standard deviation. Chi-square, Exact test and logistic regression were used to determine association of parturients’ age and booking status with mode of delivery. Level of significance was p &lt;0.05. Results: There were 556 deliveries during the study period and 269 CSs, giving a CS rate of 48.4%. Robson group 3 made the highest (27.9%) contribution to CS rate, followed by group 10 (22.3%), 5 (13.8%) and 1 (11.2%). The commonest indication for CS was cephalopelvic disproportion, followed by severe preeclampsia. Booked parturients in Robson groups 1 and 3 had 61.0% reduced odd (OR= 0.39; 95% CI = 0.15 to 0.99; p = 0.050) and 74.8% reduced odd (OR= 0.25; 95% CI= 0.14 to 0.45; p &lt; 0.001) of delivery by CS, respectively. Conclusion: The CS rate at the FMCY was contributed largely by group 3, 10, 5 and 1 parturients. Using Robson classification, CS rate can be focused to targeted intervention to optimize CS. Keywords: caesarean section rate, hospital, Robson classification, Robson 10-group. Correspondence: Olakunle Ifeoluwa Makinde. Department of Obstetrics and Gynaecology, Federal Medical Centre Yenagoa, Bayelsa State, Nigeria. Email: olakunleife@gmail.com. Mobile: +2348032136315.

Trends in caesarean section rates in Europe from 2015-2019 using Robson's Ten-Group Classification System: A Euro-Peristat registry study

Abstract Objective To assess changes in caesarean section (CS) in Europe from 2015-2019 and utilise the Robson Ten Group Classification System (TGCS) to evaluate the contribution of different obstetric populations to overall CS rates and trends Methods This was an observational study utilising routine population birth data from 28 European countries participating in the Euro-Peristat network. We included all births ≥22 weeks gestational age, from 2015 to 2019. A federated model used individual-level data from routine sources in each country formatted to common data model to generate anonymous, aggregate data tables on yearly CS rates and the Robson TGCS classification. We computed the Robson group-specific relative size, CS rate, relative and absolute contribution to overall CS rate Results Among the 28 European countries, CS rates (2015: 16.0-55.9%; 2019: 16.0-52.2%) and trends varied (-3.7-+4.7%; 9 countries decreasing, 7 stable [ ≤ ±0.2], 12 increasing). Using the Robson Classification (17 countries), in most countries, labour induction increased (Groups 2a, 4a), while multiple pregnancies (Group 8) decreased. In countries with decreasing overall CS rates, CS tended to decrease in most Robson groups, while in countries with increasing overall CS rates, CS tended to increase in most Robson groups. In countries with the greatest increase in CS rates (&amp;gt;1%), absolute contributions of Groups 1 (nulliparous term cephalic singletons, spontaneous labour), 2a and 4a, 2b and 4b (prelabour CS), and 10 (preterm cephalic singletons) to overall CS tended to increase. Conclusions Analysis of the Robson Classification shows varying CS trends and rates across Europe. Comparisons between European countries, particularly those with divergent trends, could provide insight into strategies to reduce CS without indication.

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.

FRI409 Childbirth Experiences In Women With Polycystic Ovary Syndrome

Abstract Disclosure: A.E. Husby: None. M.R. Simpson: None. R. Dalbye: None. E. Vanky: None. T.S. Løvvik: None. Introduction:Polycystic ovary syndrome (PCOS) affects 5-20% of women. Women with PCOS frequently suffer from metabolic, psychological, and reproductive comorbidities. Pregnancy complications such as gestational diabetes, pregnancy-induced hypertension, pre-eclampsia, and preterm birth are more common in PCOS. Metformin has been used in an attempt to improve pregnancy outcomes in PCOS. Childbirth experience is influenced by previous life- and birth experiences, preparedness, fear of childbirth, experiences of pain and control, and the mode and outcome of delivery. A positive childbirth experience may result in improved post-partum functioning and bonding with the newborn. In contrast, a negative childbirth experience is associated with postnatal depression, post-traumatic stress symptoms and difficulties in relating to one’s partner and newborn. To our knowledge, there are no previous studies on women with PCOS and their childbirth experiences. The primary aim of our study is to explore childbirth experiences in women with PCOS compared to a reference population. The secondary aim is to explore whether metformin vs placebo during pregnancy affects the childbirth experiences in women with PCOS. Materials and methods:This study combines data from two RCTs. In the PregMet2 study, women with PCOS in Norway, Sweden and Iceland were randomized to metformin or placebo. Main outcomes were miscarriage and preterm delivery. The Labor Progression Study (LaPS) (reference population) in Norway, compared WHO partograph to the Zhang’s guidelines for progression of labor in women in Robson group 1*. Both studies used the Childbirth Experience Questionaire (CEQ). Total CEQ scores and scores (separately) from the four domains “own capacity”, “perceived safety”, “professional support” and “participation” were compared between a) women with PCOS in the PregMet2 study (n=131) and the reference population, the LaPS study (n=3604) and b) metformin (n=179) and placebo (n=185) groups in the PregMet2 study. Results: There was no difference in total CEQ score between women with PCOS and the reference population. Women with PCOS had a higher domain score for “perceived safety” (p&amp;lt;0,05) and lower score for “own capacity” (p&amp;lt;0,05), compared to the reference population, while there was no difference in the domains “professional support” or “participation”. Total CEQ-score and domain-scores were similar for the metformin compared to placebo groups in the PregMet2 study. Conclusion: Women with PCOS compared to women in the reference population had similar childbirth experiences. However, they reported higher “perceived safety” and lower “own capacity” compared to reference women. Metformin treatment in pregnancy did not influence childbirth experience in women with PCOS. *Nulliparous women with a singleton, term pregnancy, with spontaneous start of labor and cephalic lie (Robson group 1). Presentation: Friday, June 16, 2023

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.

Achievement of appropriate cesarean rates using Robson’s 10-Group classification system in Brazilian private practice

BackgroundIncreasing cesarean section (CS) rates are a global concern because they are related to higher maternal and neonatal complication rates and do not provide positive childbirth experiences. In 2019, Brazil ranked second globally, given its overall CS rate of 57%. According to the World Health Organization (WHO), populational CS rates of 10–15% are associated with decreased maternal, neonatal, and infant mortality rates. This study aimed to investigate whether multidisciplinary care following evidence-based protocols associated with a high motivation of both women and professionals for a vaginal birth leads to less overuse of CS in a Brazilian private practice (PP).MethodsThis cross-sectional study evaluated CS rates by Robson group for women who sought vaginal birth in a private practice in Brazil comparing with Swedish data. Collaborative care of midwives and obstetricians who adopted evidence-based guidelines was offered. CS rates, overall and by Robson group, contribution of each Robson group to the overall CS rate, clinical and nonclinical interventions, vaginal birth, pre-labor CS, and intrapartum CS proportions were estimated. The expected CS rate was calculated using the World Health Organization C-model tool. The analysis used Microsoft Excel and R Studio (version 1.2.1335. 2009–2019).ResultsThe PP overall CS rate was 15.1% (95%CI, 13.4–17.1%) versus the 19.8% (95%CI, 14.8–24.7%) rate expected by the WHO C-model tool. The population included 43.7% women in Robson Group 1 (nulliparous, single, cephalic, at term, spontaneous labor), 11.4% in Group 2 (nulliparous, single, cephalic, at term, induced labor or CS before labor), and 14.9% in Group 5 (multiparous women with previous CS), the greatest contributors to higher CS rates (75.4% of them). The Swedish overall CS rate was 17.9% (95%CI, 17.6–18.1%) in a population of 27% women in Robson Group 1, 10.7% in Group 2, and 9.2% in Group 5.ConclusionsMultidisciplinary care following evidence-based protocols, associated with high motivation of both women and professionals for vaginal birth, may lead to a significant and safe reduction of CS rates even in contexts such as Brazil, with high medicalization of obstetric care and excess CS.

Cesarean section trends from 1992 to 2016 in Estonia and Finland: A registry-based study.

The number of cesarean sections (CSs) has grown steadily, but the underlying factors driving this increase remain unknown. Data from Medical Birth Registries were retrieved to analyze CS trends in Estonia and Finland during the period 1992-2016. All births in Estonia (n = 356 063) and Finland (n = 1 437 234) were included. The differences between Estonia and Finland in five-year time periods for the total CS rate, and rates in Robson 1, 2, and 5 groups (R1, R2, R5) were analyzed by logistic regression. Total CS rates were adjusted for birthweight, parity, previous CS, gestational age, singleton pregnancy, cephalic position, induction, mother's age. R1; R2; R5 rates were adjusted for birthweight and mother's age. In Estonia, the proportion of CSs increased from 6.5% to 21.0% and in Finland from 15.1% to 16.8% between 1992 and 2016. In 2016, Estonia and Finland remained within the target value with their R1 + 2 (Estonia 18%; Finland 16%) and R5 (Estonia 59%; Finland 42%) values. Comparing Robson groups in different countries can shed light on divergent CS rates and to improve the quality of perinatal and obstetric care.

Cesarean section rates according to the Robson Classification and its association with adequacy levels of prenatal care: a cross-sectional hospital-based study in Brazil

BackgroundThe rate of Cesarean section (CS) deliveries has been increasing worldwide for decades. Brazil exhibits high rates of patient-requested CS deliveries. Prenatal care is essential for reducing and preventing maternal and child morbidity and mortality, ensuring women's health and well-being. The aim of this study was to verify the association between the level of prenatal care, as measured by the Kotelchuck (APNCU – Adequacy of the prenatal care utilization) index and CS rates.MethodsWe conducted a cross-sectional study based on data from routine hospital digital records and federal public health system databases (2014–2017). We performed descriptive analyses, prepared Robson Classification Report tables, and estimated the CS rate for the relevant Robson groups across distinct levels of prenatal care. Our analysis also considered the payment source for each childbirth – either public healthcare or private health insurers – and maternal sociodemographic data.ResultsCS rate by level of access to prenatal care was 80.0% for no care, 45.2% for inadequate, 44.2% for intermediate, 43.0% for adequate, and 50.5% for the adequate plus category. No statistically significant associations were found between the adequacy of prenatal care and the rate of cesarean sections in any of the most relevant Robson groups, across both public (n = 7,359) and private healthcare (n = 1,551) deliveries.ConclusionAccess to prenatal care, according to the trimester in which prenatal care was initiated and the number of prenatal visits, was not associated with the cesarean section rate, suggesting that factors that assess the quality of prenatal care, not simply adequacy of access, should be investigated.

Indications of Induction and Caesarean Sections Performed Using the Robson Classification in a University Hospital in Spain from 2010 to 2021.

Background: The Robson Ten Group Classification System (RTGCS) enables the assessment, monitoring, and comparison of caesarean section rates both within healthcare facilities and between them, and the indications of caesarean sections (CS) performed in a maternity ward. The aims of the present study were to conduct an analysis to assess the levels and distribution of birth from a descriptive approach by CS in La Ribera University Hospital (Spain) between 2010-2021 using the Robson classification; to describe the indications for the induction of labour and the causes of caesarean sections performed; and to examine the association between the induction of labour and CS birth. Methods: A retrospective study between 1 January 2010 and 31 December 2021. All eligible women were classified according to the RTGCS to determine the absolute and relative contribution by each group to the overall CS rate. The odds ratio (OR) of the variables of interest was estimated by logistic regression. In an analysis of the subgroups, the level of significance was adjusted using the Bonferroni method. Results: 20,578 women gave birth during the study period, 19% of them by CS. In 33% of births, induction was performed, and the most common cause was the premature rupture of membranes. Group 2 (nulliparous with induced labour/elective CS before labour) accounted for the largest contribution to the overall rate of CS (31.5%) and showed an upward trend from 23.2% to 39.7% in the time series, increasing the CS rate by 6.7%. The leading cause of CS was suspected fetal distress, followed by induction failure. Conclusions: In our study, Robson Group 2 was identified as the main contributor to the hospital's overall CS rate. Determining the causes of induction and CS in a population sample classified using the RTGCS enables the identification of the groups with the greatest deviation from the optimal rate of CS and the establishment of improvement plans to reduce the overall rate of caesarean sections in the maternity unit.

A Step Toward Better Audit: The Robson Ten Group Classification System for Outcomes Other Than Cesarean Section

(Acta Obstet Gynecol Scand. 2022;101:827–835) The Robson groups, a classification system created in 2001 by Michael S. Robson, is utilized for the review of cesarean delivery (CD) rates across different groups of parturients based on parity, number of fetuses, fetal presentation, gestational age, and mode of onset of labor. This study investigated if the Robson Ten System can be extended to studying and comparing other attributes of delivery besides CD such as obstetric and sphincter injury (OASIS), operative vaginal delivery (OVD), Apgar scores, and postpartum hemorrhage.

Profile of cesarean section during COVID-19 using Robson ten group classification system in a tertiary teaching hospital, Nepal: a cross-sectional study.

A hospital-based cross-sectional study was conducted among women admitted for delivery in the Department of Obstetrics and Gynecology of a tertiary teaching hospital during the second wave of COVID-19 (1 May 2021-30 July 2021). Convenience sampling technique was applied and 1350 women were categorized into groups using Robson ten group classification system. Group size, group caesarean rate, absolute and relative contribution of each group to overall caesarean rate were calculated. Out of 1350 total deliveries during COVID-19, lower segment caesarean section was done in 446 (33.04%) (30.53-35.55 at 95% Confidence Interval). Major indication for caesarean section was previous caesarean in 185 (41.48%). Most women 202 (45.29%) were from the age group 24-30 years and gestational age between 37 and 42 weeks. Major contributor to the overall caesarean section rate was Robson group 5 (37%). This study showed higher prevalence of caesarean section delivery rate during COVID-19 pandemic than that compared with 2016 national statistics of Nepal. Despite of several challenges brought by the pandemic, pregnant women were still able to access the emergency obstetric care services in the Eastern part of Nepal. However, future studies should focus on exploring the situation in rural areas too.

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.

An analytical study on increasing number of cesarean section in a tertiary care hospital

Background: One of the most common surgeries performed worldwide is cesarean section (CS). The World Health Organization has identified an ideal CS rate for a nation of around 10–15%. In recent times, the proportion of delivery conducted by CS has increased. However, it can lead to significant increase in maternal and infant morbidity and mortality. Aims and Objectives: This study aims to analyze determine rate of CS and factors that lead to increased number of CS in a tertiary care hospital. Materials and Methods: This analytical prospective study has been carried out on pregnant women undergoing CS in Calcutta National Medical College and Hospital from March 2019 to February 2020. Total 1000 cases undergoing emergency CS during study period were included in the study. Template was generated and analysis was done on SPSS software. Results: In this study, lower segment CS (LSCS) rate is highest in age group of 20–25 years (47.2%), followed by &lt;19 years age group (24%) and lowest LSCS rates seen in &gt;35 years age group. Relationship between parity and LSCS rate is also considered in the present study. Primipara contributes around 76% LSCS rate, where multipara shows only 24% of total LSCS in this study. In respect to total number of LSCS in this study, Robson Group 2B is maximum contributor (37.4%), followed by 2A (14.4%), 4B (13.2%), and Group 6 (7.6%). Conclusion: The LSCS rate in the present study is far higher than standards which are statistically significant also. Hence, it is mandatory to assess risk and benefit ratio of mother and fetus before taking any measure to reduce LSCS rate.

The effect of anti-pandemic measures on some aspects of obstetric care in a single obstetric unit in the Slovak Republic.

< pre style="margin-bottom: 6.0pt; line-height: 150%;" > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > Objectives: < /span > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > In many countries, various anti-pandemic interventions were adopted in 2020, which also affected obstetric practices. The aim of this study is to determine their effect on the frequency of caesarean section (CS) according to Robson classification (RC). < /span > < /pre > < pre style="margin-bottom: 6.0pt; line-height: 150%;" > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > Material and methods: < /span > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > Deliveries in 2019 and 2020 were retrospectively analysed. Mothers were grouped according to RC, and the frequency of CR in the different groups were compared. < /span > < /pre > < pre style="margin-bottom: 6.0pt; line-height: 150%;" > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > Results: < /span > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > We found a statistically significant increase in the frequency of CR in the pandemic year (20.0% vs 17.8%, p = 0.0242). When classified into RC groups, the increase in the different groups lost statistical significance. Nevertheless, the increase was most important in Robson group 5 due to maternal rejection of vaginal delivery after CR and in Robson group 2b with elective CR. In spite of our expectations, the frequency of caesarean section performed due to indication of protracted labour was not increased. < /span > < /pre > < pre style="margin-bottom: 6.0pt; line-height: 150%;" > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > Conclusions: < /span > < span lang="EN-GB" style="font-size: 12.0pt; line-height: 150%; font-family: 'Times New Roman',serif;" > Interventions that were implemented during the first and second waves of the pandemic were associated with increased frequency of planned caesarean sections. < /span > < /pre >.