scholarly journals Using the Robson classification to assess caesarean section rates in Brazil: an observational study of more than 24 million births from 2011 to 2017

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Enny S. Paixao ◽  
Christian Bottomley ◽  
Liam Smeeth ◽  
Maria Conceicao N. da Costa ◽  
Maria Gloria Teixeira ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Caesarean Section Rate ◽  
Relative Size ◽  
Surgical Care ◽  
Population Based ◽  
Population Based Study ◽  
Socioeconomic Groups ◽  
Robson Classification ◽  
Lower Socioeconomic ◽  
Group 5

Abstract Background Applying the Robson classification to all births in Brazil, the objectives of our study were to estimate the rates of caesarean section delivery, assess the extent to which caesarean sections were clinically indicated, and identify variation across socioeconomic groups. Methods We conducted a population-based study using routine records of the Live Births Information System in Brazil from January 1, 2011, to December 31, 2017. We calculated the relative size of each Robson group; the caesarean section rate; and the contribution to the overall caesarean section rate. We categorised Brazilian municipalities using the Human Development Index to explore caesarean section rates further. We estimated the time trend in caesarean section rates. Results The rate of caesarean sections was higher in older and more educated women. Prelabour caesarean sections accounted for more than 54 % of all caesarean deliveries. Women with a previous caesarean section (Group 5) made up the largest group (21.7 %). Groups 6–9, for whom caesarean sections would be indicated in most cases, all had caesarean section rates above 82 %, as did Group 5. The caesarean section rates were higher in municipalities with a higher HDI. The general Brazilian caesarean section rate remained stable during the study period. Conclusions Brazil is a country with one of the world’s highest caesarean section rates. This nationwide population-based study provides the evidence needed to inform efforts to improve the provision of clinically indicated caesarean sections. Our results showed that caesarean section rates were lower among lower socioeconomic groups even when clinically indicated, suggesting sub-optimal access to surgical care.

scholarly journals Interventions to reduce caesarean section rates at government medical college and hospital Aurangabad, India

2020 ◽  
Vol 9 (4) ◽  
pp. 1563 ◽  
Author(s):  
Shrinivas Gadappa ◽  
Honey Gemavat ◽  
Sonali Deshpande ◽  
Ankita Shah
Keyword(s):  
Caesarean Section ◽  
Caesarean Section Rate ◽  
Low Risk ◽  
Respectful Maternity Care ◽  
Clinical Interventions ◽  
Medical College ◽  
Robson Classification ◽  
Foetal Monitoring ◽  
Expectant Mothers ◽  
Group 5

Background: Caesarean sections are effective in saving maternal and infant lives, but only when they are performed for medically indicated reasons, The Objective of this study was to reduce caesarean Section rate at GMCH, Aurangabad and to improve overall birthing experience with respectful maternity care.Methods: The caesarean sections done at GMCH Aurangabad were audited using Robson`s Ten Group classification system to identify the major contributors to the overall CS rate. The following clinical and non-clinical interventions were applied dynamically to control the caesarean section rates. Clinical Interventions were changes in protocols regarding induction of labour, Intermittent auscultation as opposed to continuous electronic foetal monitoring in low risk cases, use of a partogram, encouragement of different birthing positions, promoting TOLAC to reduce the secondary CS rate. Nonclinical interventions include encouragement of DOULA (birth companion), ante-natal counselling of the expectant mothers, training of healthcare staff for respectful maternity care and use of evidence based clinical practice guidelines with mandatory second opinion for every non recurrent indication of CS. Auditing of caesarean section using Robson classification.Results: In this study there has been steady decline in LSCS rates from 33% to 26.9%. On analysis with Robson classification, group 5 (previous LSCS) made largest contribution of 36.9% followed by Group 1, 2, 10 each contributed 18.01%,13.2% and 11.2% respectively. Group 6 to 10 account for 23%. Various birthing positions lowered use of oxytocics from 33 % to 19% as well lowered episiotomy rates with greater success in vaginal delivery.Conclusions: Modification of induction protocols have reduced the primary LSCS rates and successful VBAC using FLAMM score was helpful in reducing the repeat caesarean Sections. Various birthing positions, DOULA gave greater success in vaginal delivery. LSCS rates in mothers with breech, multiple or oblique/transverse lies were largely unmodifiable. Limiting the CS rate in low-risk pregnancies by individualizing every labour and not to set a time limit as long as mother and baby are closely monitored.

scholarly journals Evaluation of caesarean section practices according to Robson's 10-group classification at a level two maternity ward in Conakry, Guinea

2019 ◽  
Vol 8 (11) ◽  
pp. 4468
Author(s):  
Daniel W. A. Leno ◽  
Mamoudou E. Bah ◽  
Jerry C. Moumbagna ◽  
Tamba M. Millimouno ◽  
David Lamah ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Medical Center ◽  
Caesarean Section Rate ◽  
Relative Size ◽  
Newborn Care ◽  
Fetal Distress ◽  
Cross Sectional Study ◽  
Maternity Ward ◽  
Cross Sectional ◽  
Robson Classification

Background: The frequency of caesarean sections (CS) increased dramatically in the world over the last twenty years. The objective of this study was to evaluate caesarean section practices based on Robson classification in an urban referral hospital in Conakry, GuineaMethods: We conducted a cross-sectional study of 2,266 birthing records collected at the maternity ward of the Coronthie Communal Medical Center in Conakry, from January 1st to December 31st 2016. We included in the study all women who had a caesarean section and whose medical records were complete. Robson's classification was used to classify women into 10 groups based on maternal and fetal characteristics. The relative size of each group, its gross caesarean section rate as well as its contribution to overall caesarean section rate and the main caesarean section indications were calculated.Results: In 2016, 769 caesarean sections were performed out of 2,266 deliveries, corresponding to a hospital section rate of 33.9%. Groups 5 (11.0%), 1 (4.8%), and 3 (4.3%) of the Robson classification were the most contributors to registered hospital caesarean section rate. The main indications for caesarean section were uterine scar in group 5 and acute fetal distress in groups 1 and 3.Conclusions: The systematic reference to the Robson classification could help to identify and avoid the relative indications of the caesarean section in urban Guinea. Besides, increasing induction of labor and strengthening providers’ capacities in emergency obstetric and newborn care services could contribute to reduce caesarean section rates in Guinea.

scholarly journals The ten group Robson classification: a retrospective study to identify strategies to optimise caesarean section rates

2020 ◽  
Vol 9 (12) ◽  
pp. 5082
Author(s):  
Spandana S. ◽  
Amarpali K. Shivanna
Keyword(s):  
Retrospective Study ◽  
Caesarean Section ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Group Classification ◽  
Care Hospital ◽  
Robson Classification ◽  
Vaginal Deliveries ◽  
Group 5 ◽  
Ongoing Surveillance

Background: Caesarean section rates have been increasing worldwide. For proper assessment, the ten group Robson classification is recommended by WHO for assessing CS rates. We are analyzing the caesarean section rates by classifying the caesarean sections using modified Robson’s ten group classification. Objective of the current study was to estimate caesarean section rates in our hospital and to classify caesarean section using modified Robson’s ten group classification system.Methods: Current retrospective study was conducted in the department of obstetrics and gynaecology in a tertiary care hospital. The medical records were reviewed for a period of 12 months.Results: Total number of deliveries during the study period was 315. The total numbers of caesarean section were 159 and total vaginal deliveries were 156. The caesarean section rate was 50.47%. The main contributors to overall caesarean section rate were group 5 (18.10%), group 2 (13.96%) and group 1 (5.71%). Women with one previous LSCS contributed majorly to the caesarean section rate. Higher CS rate was also seen in both group 2A (69.40%) and group 4A (47.30%) which had underwent induction of labour. More inclination towards trial of labour following CS for women with previous one LSCS can lower CS rates.Conclusions: Modified Robson’s classification is easily implementable and an effective tool for ongoing surveillance. The results can be compared between Institutions, states and countries. Having implemented the Robson classification and identified groups which contributed the most to the overall CS rate, interventions to reduce the same has to be our prime objective.

scholarly journals Analysis of caesarean section rate according to modified Robson’s classification at tertiary care centre in Uttarakhand, India

2019 ◽  
Vol 8 (4) ◽  
pp. 1288
Author(s):  
Kusum Dogra ◽  
Neetu Arora ◽  
Bhawna Sharma ◽  
Meenakshi Tanwar
Keyword(s):  
Caesarean Section ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Maternal Characteristics ◽  
Robson Classification ◽  
Group 4 ◽  
Spontaneous Labour ◽  
Group 5

Background: High caesarean section rate worldwide including India is matter of concern. The aim of this study is to analyse caesarean section rate at tertiary care centre according to Modified Robson’s classification.Methods: This retrospective study was conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIMHS) and Shri Mahant Indiresh Hospital at Dehradun from April 2018 to September 2018. All women delivered during this period were classified according to modified Robson’s classification using their maternal characteristics and obstetric history. For each group, authors calculated the caesarean section rate within the group and its contribution to overall caesarean section rate.Results: Out of total 1302 women delivered, 395 underwent CS (30.3%).The major contribution to overall caesarean section rate was 33.4% by group 5 (Previous CS, singleton, cephalic, >37weeks) followed by 16.7% by group 1 (nullipara, singleton, cephalic, >37 weeks, spontaneous labour), 12.4% by group 3 ( multipara, singleton, cephalic, >37 weeks, spontaneous labour ).CS rates among various group ranges from 100% among women with abnormal lie (group 9) to 77.5% in nulliparous breech (group 6), 73.7% in previous CS (group 5) and least 11.2%  in multipara induced or pre labour CS (group 4).Conclusions: Modified Robson classification is simple, systematic, reproducible and can be effectively utilized in analyzing delivering women. Major contribution to overall caesarean section is made by previous CS.

scholarly journals CS in Uruguay From 2008 to 2018: Country Analysis Based on the Robson Classification

2021 ◽  
Author(s):  
Mercedes Colomar ◽  
Valentina Colistro ◽  
Claudio Sosa ◽  
Ana Pilar Betrán ◽  
Suzanne Serruya ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Private Sector ◽  
Lower Risk ◽  
Caesarean Section Rate ◽  
Geographical Area ◽  
Capital City ◽  
Robson Classification ◽  
Country Level ◽  
Relative Contribution ◽  
Group 5

Abstract Background: The use of caesarean section has steadily increased all over the globe, with Latin America being the region with the highest rates. Multiple factors account for that increase. The Robson classification is appropriate to systematically evaluate and compare determinants at the clinical level for caesarean section rates over time, as well as to account for local and international needs. The purpose of this study is to describe the evolution of caesarean section rates by Robson groups in Uruguay from 2008 to 2018 using a country level database.Methods: Caesarean section rates were calculated by Robson groups for each of the years included, disaggregated by care sector (public/private) and by geographical area (Capital City/Non-Capital).Results: Among the groups at lower risk of caesarean section (1 to 4), the highest rates of caesarean section were seen in women in group 2B, followed by those in group 4B. Women in groups 2B, 3 and 4 (A and B) (Figure 2) had a significant increase in the number of caesarean section in those 11 years. A significant growth was also observed in groups 5, 8, and 10. A tendency towards a relative increased was seen in groups 2A, 3, 4A-B, and 5 (Figure S5 – Supplementary Material). The private sector had higher rates of caesarean section for all groups throughout the period, except for women in group 9. The private sector in Montevideo presented the highest rates in the groups with the lowest risk of caesarean section 1, 2A, 3 and 4A, followed by the private sector outside of the capital. The analysis of the relative contribution to the overall caesarean section rate, showed that group 5 was the one with the highest contribution, and it kept growing steadily over the years, while there was a decrease in the relative contribution of group 1 to the overall caesarean section rate.Conclusion: Uruguay is no exception to the increasing caesarean section trend, even in groups of women who have lower risk of requiring caesarean section. The implementation of interventions aimed at reducing caesarean section in the groups with lower obstetric risk in Uruguay is warranted.

scholarly journals Analysis of caesarean delivery using Robson ten group classification system at a tertiary care teaching institute in Kerala, India

2019 ◽  
Vol 8 (5) ◽  
pp. 1990
Author(s):  
Heera Shenoy T. ◽  
Sheela T. Shenoy ◽  
Anaswara T. ◽  
Remash K.
Keyword(s):  
Caesarean Section ◽  
Classification System ◽  
Caesarean Delivery ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Group Classification ◽  
College Hospital ◽  
Robson Classification ◽  
Group 5 ◽  
Group 2

Background: Globally, the caesarean delivery rate is rising continuously, making caesarean one of the most common surgical procedures. The Robson classification, appreciated by WHO in 2014 and FIGO in 2016 is widely accepted, risk-based, ten-group classification system (TGCS) developed specifically to assess caesarean section rates. The aim of this study was to know the rate of Caesarean section in present hospital, to analyse the Caesarean sections based on Robson’s classification and to determine the contribution and significance of each group on the overall number of Caesarean sections.Methods: All women, who gave birth by Caesarean deliveries done over a period of 1 year (January 2018-December 2018) in Travancore Medical College Hospital in South Kerala India.Results: Group 5 (previous LSCS, single, cephalic >37 weeks) made the greatest contribution to the Caesarean section rate (27.24%). The second highest contributor was Group 2 (Nulliparous, singleton, cephalic, >37 weeks induced labour or caesarean section before labour followed by Group 10 (all single cephalic <36 weeks including previous CS) 18.78%.Conclusions: Limiting the CS rate in low-risk pregnancies is key to lowering the trend of increased CS. If TGCS is used uniformly, CS rates can be compared over time and between units, both nationally and internationally.

scholarly journals Caesarean section in Palestine using the Robson Ten Group Classification System: a population-based birth cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e022875 ◽  
Author(s):  
Mohammed Walid Zimmo ◽  
Katariina Laine ◽  
Sahar Hassan ◽  
Bettina Bottcher ◽  
Erik Fosse ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Preterm Labour ◽  
Caesarean Section Rate ◽  
Population Based ◽  
Full Term ◽  
Birth Cohort Study ◽  
Multiple Pregnancies ◽  
Term Pregnancy ◽  
Group 5 ◽  
Labour Group

ObjectiveTo analyse the current situation of caesarean section in Palestine using the Robson Ten Group Classification System (TGCS).DesignA population-based birth cohort study.SettingObstetrical departments in three governmental hospitals in Gaza.ParticipantsAll women (18 908) who gave birth between 1 January 2016 and 30 April 2017.MethodsThe contributions of each group to the study population and to the overall rate of caesarean section were calculated, as well as the rate of caesarean section in each TGCS group. Differences in proportions between study hospitals were assessed by χ2test.Main outcome measuresThe main outcome was the contributions of each group to the overall caesarean section rate.ResultsThe overall rate of caesarean section was 22.9% (4337 of 18 908), ranging from 20.6% in hospital 1 to 24.6% in hospital 3. The largest contributors to the overall caesarean section rate were multiparous women with single cephalic full-term pregnancy who had undergone at least one caesarean section (group 5, 42.6%), women with multiple pregnancies (group 8, 11.6%) and those with single cephalic preterm labour (group 10, 8.1%). Statistically significant differences in caesarean section rates between the study hospitals were observed in group 1 (nulliparous women with single cephalic full-term pregnancy and spontaneous labour), group 4 (multiparous with single cephalic full-term pregnancy with induced labour or prelabour caesarean section), group 5 (multiparous with single cephalic full-term pregnancy with previous caesarean section) and in group 7 (multiparous with breech presentation).ConclusionWomen in groups 5, 8 and 10 were the largest contributors to the overall caesarean section rate in the study hospitals. Efforts to reduce the differences in obstetrical care between hospitals need to be directed towards increasing the proportion of vaginal births after caesarean section and by reducing primary caesarean section in multiple pregnancies and preterm labour.

scholarly journals Analysis of Caesarean section rate in a government teaching institute based on Robson’s ten group classification

2018 ◽  
Vol 8 (1) ◽  
pp. 140
Author(s):  
Kavita Sambharam ◽  
Mansi Lalit Verma ◽  
Pradip W. Sambarey
Keyword(s):  
Caesarean Section ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Relative Size ◽  
Group Classification ◽  
Present System ◽  
Maternal Characteristics ◽  
Care Indicator ◽  
Spontaneous Labour ◽  
Group 5

Background: Caesarean section rate is a qualitative health care indicator in India. With increasing rates of caesarean sections and no defined method to audit present institutes it is the need of the hour to use tools like Robson’s classification to understand present system. The aim of this study was to determine the rate and analyse Caesarean sections in a tertiary care institute using Robson’s ten group classification system.Methods: This is a retrospective analytical study in which all Caesarean section done over a period of 3 years (July 2014-June 2017) were included which were performed in single unit (out of 6) of Department of Obstetrics and Gynecology of Sassoon General Hospital. Women were classified in 10 groups according to Robson’s classification, using maternal characteristics and obstetrical history. For each group, authors calculated its relative size and its contribution to the overall caesarean rate.Results: Total deliveries were 4750 out of which 985 were Caesarean section, incidence was calculated as 20.7%. The main contributors to the overall Caesarean rate were primiparous women in spontaneous labour (group 1- {18.3%}) and women with previous caesarean section (group 5- {34.9%}).Conclusions: The Robson’s classification is an easy tool to use and identify the current changing dynamics in any hospital setup. Its implementation as an obstetric audit can help lower the Caesarean rates and improve the standards based on WHO criteria.

scholarly journals Study of Caesarean Section using Robson’s Classification at Provincial Public Hospital

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Murari Thakur
Keyword(s):  
Caesarean Section ◽  
Public Hospital ◽  
Caesarean Section Rate ◽  
Relative Size ◽  
Group Classification ◽  
Previous Cesarean Section ◽  
Rate Study ◽  
Group 5 ◽  
A Prospective Study ◽  
Previous Cesarean

Aims: To categorize all pregnant women admitted for delivery at Provincial Public Hospital Janakpurdham according to Robson’s ten group classification and to assess the caesarean section rate and identify the indications contributing to the same. Methods: This is a prospective study conducted at Provincial Public Hospital Janakpurdham for 3 months from 15 th April to 15 th July 2020 .Total of 1536 participants admitted for delivery including 257 undergoing caesarean section were included in the study and were classified according to the Robson’s classification. For each group, demographic and obstetric profile, relative size and its contribution to the overall caesarean rate was calculated. Results: The overall caesarean section rate was 16.7% (257 among 1536 total deliveries). Robson’s Group 5(Previous caesarean section, singleton cephalic, ≥37 weeks) was the major contributor (46%) to the overall caesarean section rate followed by Group 2b (nullipara, singleton cephalic, ≥37 weeks, caesarean section before labor) (15.6%). Conclusion: Induction of labor for Group 2a and 4a should be done and trial for vaginal delivery in previous Cesarean section for Group 5 should be promoted to reduce the caesarean section rate. Study result is limited by lack of labor induction facility at the study site.

scholarly journals Caesarean Section Analysis of the Rate According to Robson Ten Group Classification

2021 ◽  
Vol 8 (01) ◽  
pp. 37-42
Author(s):  
Srividhya R ◽  
Jhansi Rani K
Keyword(s):  
Caesarean Section ◽  
Classification System ◽  
Placenta Previa ◽  
Caesarean Section Rate ◽  
Relative Size ◽  
Group Classification ◽  
Nulliparous Women ◽  
Increased Risk ◽  
Group 5 ◽  
Group 1

BACKGROUND In current and subsequent births, Caesarean sections bear their own risks for maternal and perinatal morbidity and mortality. In contrast with vaginal delivery, Caesarean section has increased risk of blood transfusion, hysterectomy and death and the risk of uterine rupture, placenta accreta and placenta previa in future pregnancies is also increased. We wanted to analyse the Caesarean section rate using Robson ten group classification system & identify the leading groups contributing to high caesarean section rates using Robson ten group classification system. METHODS This observational descriptive study enrolled 11,090 women who underwent delivery, of whom 5117 (46.14 %) women delivered vaginally and 5973 (53.86 %) women delivered through Caesarean section. RESULTS Overall caesarean section percentage was 53.86 %. Major contributors for the CSR were Group 5, 2 and 1 in that order. CS rate in Group 5 and 1 is relatively increased. Ratio of relative size of Group 1 and 2 is 1:2 indicating a greater number of prelabour caesarean sections in nulliparous women. Caesarean section rate in Group 1 and 2 was 15.7 % and 20.1 % respectively. The main indications for caesarean sections being fetal distress, non-progressive labour and severe oligohydramnios / anamnios. Relative size of Group 1 and 5 was 47.3 % stating that most of the obstetric population was in Group 1 and 5. Caesarean section rate in Group 3 and Group 4 was relatively higher than expected; this may be due to our institute being a referral center. Group 5 contributed 45.7 % to overall caesarean section rate. CONCLUSIONS Standardisation of indication of Caesarean deliveries, regular audits and definite protocols in hospital will aid in decreasing the Caesarean section rate in hospital. KEYWORDS Kidney Size, Ultrasound Assessment, Age Groups

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