Increasing caesarean section rates among low-risk groups: a panel study classifying deliveries according to Robson at a university hospital in Tanzania

Int J Reprod Contracept Obstet Gynecol

Jose

2017

Background: With Caesarean sections on the rise WHO proposes that health care facilities use the Robson's 10 group classification system to audit their C-sections rates. This classification would help understand the internal structure of the CS rates at individual health facilities identify key population groups, indications in each group and formulate strategies to reduce these rates.Methods: This was a cross sectional study for a period of 24 months at a tertiary care hospital in a tribal area of Kerala South India. Women who delivered during this period were included and classified into 10 Robson's classes and percentages were calculated for the overall rate, the representation of groups, contribution of groups and Caesarean percentage in each group.Results: Highest contribution was by Group 5 and Group 2. Together these two groups contributed to 38% of the total Caesareans. Followed by Group 8 and 10. All four added contributed to 63% of the section rate The least contribution was by Group 3. Groups 6, 7 and 9 by themselves did not contribute much but within their groups had a 100% C-Section rate.Conclusions: The contribution of the various Robson's Group to the absolute C-Section rates needs to be looked into. Reducing primary section rates, adequate counselling and encouraging for VBAC, changing the norms for dystocia and non-reassuring fetal status, training and encouraging obstetricians to perform versions when not contraindicated could reduce the contribution of Robson's groups towards the absolute C-Section rates.

“…[1][2][3] Developed countries like the Unites States have seen a drastic rise in C-Sections from 1996 to-2011. 4 The developing world too has seen a similar rise.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Caesarean-Section rates according to Robson's ten group classification system and evaluating the indications within the groups

Int J Reprod Contracept Obstet Gynecol

Jose

2017

“…Litorp et al [11] in Dar es Salaam-Tanzania also found that Groups 1, 3 and 5 are the largest contributors to the overall caesarean section rate in their university hospitals.…”

Section: K Achille Et Al Open Journal Of Obstetrics and Gynecologymentioning

confidence: 96%

“…However, our Caesarean section rates are between 35.2% and 52.1% reported by Farghali et al [10] respectively in two Cairo hospitals (academic and military) in Egypt in 2014. In Tanzania in 2013, Litorp et al [11] noted a dramatic increase in the caesarean section rate in a decade from 19% to 49%. The average caesarean rate in this university hospital was 46% during the study period.…”

Section: Discussionmentioning

confidence: 99%

How Referred Patients Influence Cesarean Sections Rate Pattern: Analysis according to the Robson Classification

Achille¹,

Didier²,

Charles³

et al. 2017

OJOG

Objective: To improve the practice of cesarean section by analyzing the cesarean section according to Robson's classification. Methodology: This was a cross-sectional and descriptive study carried out at the University Hospital of Cocody. It covered the Cesarean sections performed during the year 2015 and ranked according to the 10 groups of Robson. Results: The overall Cesarean section rate in 2015 was 42.8% (3100 cesarean sections for 7229 deliveries). Group 1 was the largest contributor to overall Cesarean section with a rate of 20.5% followed by Group 3 (18.6%), Group 5 (16.4%) and Group 10 (12.2%), unlike other data in the literature where groups were in descending order Groups 5, 1, 3. This difference was driven by medical evacuations and our working conditions. Conclusion: The Cesarean section rate is constantly increasing in our department. Referred patients played a huge role in the distribution of C-section along the Robson's 10 groups classification.

“…4 When it comes to such centres the C-Section rates have been found to be universally higher both in the developed and the developing worlds. [1][2][3][4] The reason could be due to differences in the cases that that they deal with depending upon their geographical location, the obstetric profile of the cases, social and logistical factors This would make it difficult to have a generalized or uniformly appropriate C-Section rate.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] In 1985 WHO stated that a C-section rate of above 15% is not justifiable at the same time stressed that every effort be made to provide CSection when needed rather than aim for a particular rate. 6 It is very difficult at the level of an individual health care facility, particularly tertiary care centre to determine an appropriate rate of CS.…”

Section: Introductionmentioning

confidence: 99%

Comparing WHO C-Model generated C-Section probabilities to actual delivery outcomes in a tertiary care centre

Gopi

Int J Reprod Contracept Obstet Gynecol

2017

Background: A model which takes into account several relevant factors and gives the probability of C-Section in a woman would have the advantage of preparing for such an event. The identification of women at high risk of C-Section (>50% risk) would provide the opportunity for understanding risks involved in pursuing a vaginal delivery whereas if the risk of C-Section was less (<50%) it would prove useful in counselling for a vaginal delivery. We used the WHO C-Model with the aim to find the predictability of this model in our facility and the overuse of C-section in the 10 Robson’s Groups.Methods: A retrospective observational study in which all women who gave birth at our hospital from June 2016 to May 2017 were included and C-Section probability was calculated using the C-Model. Comparison with the actual mode of delivery was done to find the sensitivity, specificity, positive and negative predictive value of the model and the overuse of C-Section in the Robson’s Groups.Results: Out of the 314 C-Sections done only 45 women had a >50% probability, giving the model a sensitivity of 14.33%, specificity of 98.8%, positive predictive value of 90% and negative predictive value of 60.56%. Robson’s Groups 5 and 3 demonstrated the greatest overuse of C-Sections.Conclusions: The WHO Model when applied to this centre showed a high positive predictive value for C-Sections but the negative predictive value or the ability to correctly predict a vaginal delivery was much less.