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

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.

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The ten group Robson classification: an institutional study to analyse the caesarean section rates

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20213220 ◽

2021 ◽

Author(s):

Lekshminath Gopinath ◽

Rajani Vaidya

Keyword(s):

Caesarean Section ◽

Policy Making ◽

Tertiary Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Robson Classification ◽

Relative Contribution ◽

Obstetrics And Gynaecology ◽

Vaginal Deliveries ◽

Group 5

Background: Over the last few decades, there has been an alarming increase in the rate of deliveries by caesarean section (CS) in most of the countries, though the drivers of this trend are not completely understood. In 1985, WHO had proposed that ideal rate for regional CS rates should not exceed 10-15%. The Robson’s classification system is simple, robust and flexible. The study was done as it was important to have a tool to monitor, compare the CS rates in a same setting and between different settings over a period of time and to optimise the CS rates.Methods: It was a retrospective study conducted in the department of obstetrics and gynaecology in a tertiary care centre. The hospital delivery records were reviewed for a period of 15 months from April 2020 to June 2021.Results: The total number of deliveries during the study period was 1016. The total number of CSs was 441 and the total number of vaginal deliveries was 575.The CS rate was 43.4%. The relative contribution from groups 1, 2 and 5 in our study accounted for 76.36% and group 5 accounted for 44.4% of the total CSs. These 3 groups should be the focus of attention to reduce the overall CS rates.Conclusions: It is advisable that all institutions can use the Robson’s report table to analyse the population catered by them and to make institutional specific policies. This will allow comparing the data amongst the different institutions and countries which can help in policy making.

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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201224 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1563 ◽

Cited By ~ 1

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.

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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20204958 ◽

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.

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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20191091 ◽

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.

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Analysis of caesarean sections at a tertiary care centre according to Robson’s criteria

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203339 ◽

2020 ◽

Vol 9 (8) ◽

pp. 3445

Author(s):

Ipsita Mohapatra ◽

Subha Ranjan Samantaray ◽

Achanta Vivekanand ◽

Anandala Manjula ◽

Buyyani Priyanka

Keyword(s):

Caesarean Section ◽

Caesarean Section Rate ◽

Tertiary Care ◽

Group Classification ◽

Tertiary Care Centre ◽

Civil Hospital ◽

Relative Contribution ◽

Still Births ◽

Group 5 ◽

Uterine Scar

Background: There has been a considerable increase in the rate of caesarean sections in the past few decades. Some demographers have argued that this increase is largely affected by the uprising trend of new medically indicated caesarean sections. M. S. Robson proposed a ten-group classification of caesarean sections in year 2001 which was appreciated by WHO in 2014 and FIGO in 2016. This classification is known as Robson’s classification which has ten groups.Methods: This is a retrospective study which was carried out at Civil Hospital, Karimnagar. The study group included all live births and still births of at least 500 gm birth weight or at least 28 weeks of gestation at Civil Hospital, Karimnagar during the period from October 2019 to December 2019. The data collected was analysed using simple statistical methods like percentage and proportion. The data was grouped according to the Robson’s 10 group classification system. The overall caesarean section rate, size of each group and the relative contribution of each group to the overall CS rate were calculated.Results: The total number of deliveries during the study period was 2493. Out of these, the number of caesarean deliveries was 1345. The caesarean section rate was calculated to be 53.95%. The group 5 (multiparous with at least one previous uterine scar with single cephalic pregnancy ≥37 weeks of gestation) contributed to 38.07% of the total caesarean section rate which is the highest.Conclusions: A regular audit into the number and indications of caesarean sections will definitely help in decreasing the primary and repeat caesarean sections.

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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20191956 ◽

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.

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

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04060-5 ◽

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.

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Caesarean section at Koudougou regional hospital centre: indications and prognosis

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205211 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4792

Author(s):

Djiguemde Nebnomyidboumbou Norbert Wenceslas ◽

Lankaonde Martin ◽

Savadogo-Komboigo B. Eveline ◽

S. I. B. Sansan Rodrigue ◽

Ouedraogo Wendlassida Estelle ◽

...

Keyword(s):

Caesarean Section ◽

Cesarean Section ◽

Caesarean Section Rate ◽

Cross Sectional Study ◽

Cross Sectional ◽

Important Place ◽

History Of ◽

Group 3 ◽

Group 5 ◽

Uterine Scar

Background: Objective was to study the indications and the prognosis of cesarean section in the obstetrics and gynecology department of CHR Koudougou from August 1st to October 16th 2018.Methods: This was a cross-sectional study for descriptive purposes with prospective collection of data over the month and monitoring of parturients up to the 42nd day post caesarean section. The study covered the period from August 1 to October 16, 2018. Gestures received in the work room and those hospitalized for a scheduled cesarean were involved in this study.Results: This study involved 316 deliveries. The caesarean section rate was 34.8% (n=110). The average age was 26.75 years with extremes of 12 and 42 years. Term pregnancies represented 90.9%. History of cesarean section was observed in 47, 3%. The main groups contributing to the caesarean section rate represent: Groups 5 (9.5%), Group 1 (9.2%), Group 3 (5.1%), the scar uterus (17.3%) and suffering fetal (14.6%). The reported complications were 15.5% including 3.6% parietal suppuration and 0.8% stillbirth.Conclusions: The caesarean section occupies an important place in the maternity service of the RHC of Koudougou. Robson's group 5 was the largest contributor to the overall cesarean rate in our study. Measures should be taken in this group so that the uterine scar does not become an absolute indication for cesarean.

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