Application of the Robson Classification in Assessing Cesarean Section Rates: An Audit of a Tertiary Care Hospital’s Gynecology Department in Karachi, Pakistan

Abstract

Objective: The increasing rate of cesarean sections (CS) is a significant concern for healthcare providers worldwide. The World Health Organization (WHO) recommends that CS rates should not exceed 10-15% at the population level. The Robson classification system is a widely used tool for assessing and comparing CS rates based on the indications and patient population across different hospitals and obstetric populations. This audit report will help identify areas for improvement in obstetric care practices and facilitate the development of strategies to optimize obstetric care and reduce CS rates, thereby improving maternal and neonatal outcomes. Methods: This retrospective study utilizing hospital records was conducted from January 1st, 2022, to December 31st, 2022, at the Department of Obstetrics and Gynecology in Holy Family Hospital, Karachi, Pakistan. During the study period of one year, a total of 449 cesarean sections were conducted, which were classified into the ten groups of The Robson Classification. Group CS rate, Group size, Relative contribution of group to overall CS rate, and Absolute group contribution to overall CS rate was calculated for each group. Overall indications of CS in all groups was analyzed and based on the results interventions were suggested to be implemented to optimize CS. Results: 1464 women were delivered during this one year period. A total of 507 CS were our population of interest. Of the cesarean sections performed, 48.8% (247) were elective and 51.2% (260) were emergency. The Robson classification group 5 (51.9%), group 2 (18.5%), and group 10 (14.4%) respectively were the major contributor to the overall CS rate. The main indications for CS were previous history of caesarean section (32.3%), non-progress of labor (21.15%), and cephalopelvic disproportion (16.92%). Conclusion: It is crucial to develop strategies to decrease the unnecessary CS rate while ensuring safe and appropriate obstetric care. Furthermore, there is a need for further research to identify the underlying factors contributing to the high CS rates and to develop effective interventions to address this issue. Implementation of these strategies may lead to improved maternal and fetal outcomes, reduced healthcare costs, and increased patient satisfaction.