Utility of the Robson Ten Group Classification System to determine appropriateness of caesarean section at a rural regional hospital in KwaZulu-Natal, South Africa

Abstract

Background. High caesarean section (CS) rates are not only costly but associated with significant perinatal and maternal morbidity and mortality. It has recently been suggested that structured auditing of CSs may identify those groups in the obstetric population that contribute substantially to the high rates and for which focused interventions may bring about change. Objective. To evaluate the utility of the Robson Ten Group Classification System (RTGCS) in determining appropriateness of CS at a regional rural hospital in KwaZulu-Natal Province, South Africa. Methods. A retrospective review of the hospital records of women delivered by CS over a 3-month period was performed. The RTGCS was used to categorise women according to parity, age, past obstetric history, singleton or multiple pregnancy, fetal presentation, gestational age and mode of onset of labour/delivery. Results. There were 2 553 hospital births over the 3-month study period. The CS rate was 42.4% (1 082/2 553). According to the RTGCS, groups 1 (n=296, 27.4%), 5 (n=186, 17.2%) and 10 (n=253, 23.4%) were substantial contributors to the overall CS rate. The main indications for CS were fetal distress (36.5%) and cephalopelvic disproportion (26.8%). Conclusion. The RTGCS is a useful tool with which to identify patient groups warranting interventions to reduce high CS rates in a rural regional hospital setting. Group 1 (nullipara: single cephalic term pregnancy; spontaneous labour) warrants the most attention. Applying stricter criteria and due diligence in decision-making for primary CS may decrease the high CS rates.

Analysis of caesarean sections using Robson’s classification system in a tertiary care centre in Northern India: an emerging concept to audit the increasing caesarean section rate

“…Makhanya et al recommends this system for auditing CS rates within healthcare systems. 13 In present study, the rate of caesarean section in our hospital (46.12%) is quite higher than what has been considered by WHO as 15% of all deliveries. The caesarean section rate depicted in year 2013-2014 in India was 16.4%.…”

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

“…It also helps to identify the group which contributes to maximum number of caesarean sections, which will finally lead to steps and protocols to decrease the CS rates within the health care sector. 6 The caesarean section rate in this study was found out to be 53.95%. This rate is found to be similar to the study done by Jacob KJ et al 1 This rate is very high, but this high rate is mainly because of the fact that our hospital is a referral centre and has a large number of complicated cases like pre-eclampsia, eclampsia, un-controlled gestational diabetes etc., which need immediate termination of pregnancy by caesarean section.…”

The outcome of newborns admitted to kangaroo mother care units at regional hospitals in KwaZulu‑Natal, South Africa

“…Half (51%) of the mothers had a caesarean section, which is higher than the provincial average for KZN of 30.7% [16] but similar to the 42.4% reported from the Lower Umfolozi War Memorial District Hospital. [17] However, the mode of delivery did not influence the newborn outcome. Although there was a predominance of female babies and they had a slightly lower proportion with a poor outcome, this factor was not statistically significant.…”