ASSESSMENT OF CAESAREAN SECTION RATE USING ROBSON TEN GROUP CLASSIFICATION SYSTEM IN A TERTIARY CARE HOSPITAL: A CROSS SECTIONAL STUDY
AbstractBackground: The growing rate of caesarean section is a major concern for quality of maternal life and public health. Concerns about such increases prompted the WHO to recommend Robson ten group classification system for assessing the Caesarean Section rate. The present study's aim was to assess the caesarean rate using Robson's ten group classification system and highlighted the reliable information system, in turn, helps to construct interventions to reduce avoidable caesareans. Methods: This cross-sectional study was carried out on 5796 women who delivered from 25th November 2021 to 24th November 2022 in Jinnah Post Graduate medical Centre Karachi. Data was collected from the women admitted for delivery using Robson's pro forma. Relative size and caesarean rate of each group and overall caesarean section rate was calculated. Results: Of the total 5796 deliveries, 2141 (36.9%) were caesarean deliveries and 3655 (63.1%) had normal deliveries. Out of Robson's ten groups system, Group 10 had a higher contribution of 705 (12.2%) to the overall caesarean rate followed by group 5 had 627 (10.8%). The contributing prevalence of Group 1, 2, 3, 4, 6, 7, 8 and 9 were 122 (2.1%), 317 (5.5%), 50 (0.87%), 167 (2.9%), 42 (0.72%), 35 (0.6%), 49 (0.85%) and 27 (0.46%) respectively. Conclusion: Our study concluded that Group 10 and 5 were the most responsible for the whole Caesarean Section rate. In all contributing groups, there is a need to identify the indications and to sub classify these groups further so that preventable caesarean sections can be avoided by reducing these factors.
Tontus HO, Nebioglu S. Improving the caesarean decision by robson classification: a population-based study by 5,323,500 livebirth data. Ann Glob Health 2020;86(1):101.
Visser GH, Ayres-de-Campos D, Barnea ER, de Bernis L, Di Renzo GC, Vidarte MF, et al. FIGO position paper: how to stop the caesarean section epidemic. Lancet 2018;392(10155):1286–7.
WHO. Appropriate technology for birth. Lancet 1985;2(8452):436–7.
National Institute of Population Studies (NIPS) [Pakistan] and ICF. Pakistan Demographic and Health Survey 2017-18. Islamabad, Pakistan, and Rockville, Maryland, USA: NIPS and ICF; 2019.
Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health 2021;6(6):e005671.
WHO. Caesarean section rates continue to rise, amid growing inequalities in access. Geneva: World Health Organization; 2021.
Ganeriwal SA, Ryan GA, Purandare NC, Purandare CN. Examining the role and relevance of the critical analysis and comparison of caesarean section rates in a changing world. Taiwan J Obstet Gynecol 2021;60(1):20–3.
Tura AK, Pijpers O, de Man M, Cleveringa M, Koopmans I, Gure T, et al. Analysis of caesarean sections using Robson 10-group classification system in a university hospital in eastern Ethiopia: a cross-sectional study. BMJ Open 2018;8(4):e020520.
Ali Y, Khan MW, Mumtaz U, Salman A, Muhammad N, Sabir M. Identification of factors influencing the rise of caesarean sections rates in Pakistan, using MCDM. Int J Health Care Qual Assur 2018;31(8):1058–69.
WHO. WHO statement on caesarean section rates. World Health Organization; 2015.
Sah S, Goel R, Goel JK. Analysis of caesarean section rate according to Robson's criteria in tertiary care centre. Int J Reprod Contracept Obstet Gynecol 2018;7(8):3060–5.
Boatin AA, Cullinane F, Torloni MR, Betrán AP. Audit and feedback using the Robson classification to reduce caesarean section rates: a systematic review. BJOG 2018;125(1):36–42.
Robson MS. Can we reduce the caesarean section rate? Best Pract Res Clin Obstet Gynaecol 2001;15(1):179–94.
Rai SD, van Teijlingen E, Regmi P, Wood J, Dangal G, Dhakal KB. Classification of Caesarean Section: A Scoping Review of the Robson classification. Nepal J Obstet Gynecol 2021;16(1):2–9.
Abbas F, Amir ud Din R, Sadiq M. Prevalence and determinants of Caesarean delivery in Punjab, Pakistan. East Mediterr Health J 2018;24(11):1058–65.
Abd Al Karim M, Hadi WM, Abed MT, Ameen WA, Obaid HM. Indications and Common Complications of Caesarean Section: An Overview Study. Eurasian Med Res Period 2021;3:40–4.
Okyere J, Duah HO, Seidu AA, Ahinkorah BO, Budu E. Inequalities in prevalence of birth by caesarean section in Ghana from 1998-2014. BMC Pregnancy Childbirth 2022;22(1):64.
Khowaja B, Mughal FB, Valliani K. The Factors Influencing Caesarean-Section Rates-A Narrative Review from Pakistan. Pak J Med Res 2021;60(3):143–7.
Hassan L, Woodbury L, Jamal N, Baral G, Ferdous J, Sohail R, et al. Examining the Efficacy of the Robson Classification System for Optimizing Caesarean Section Rates in South Asia. J South Asian Fed Obstet Gynaecol 2021;12(6):366–71.
Zijaj L, Shtylla A, Kerpaci J, Dajti I. The analysis of Caesarean Section Rate based on 10 groups Robson’s Classification. Eur J Med Natur Sci 2021;4(2):71–80.
Ali S, Khattak S, Sadaf R, Begum S, Kishwar N. Caesarean Section Rate and Frequencies of Indications Using Robson–Ten Classifications. J Gandhara Med Dent Sci 2021;8(4):43–7.
Imtiaz R, Husain S, Izhar R. Adoption of Robson's Ten Group Classification System (RTGCS) to analyse caesarean section rates at a tertiary care centre in Pakistan. Ann Abbasi Shaheed Hosp Karachi Med Dent Coll 2018;23(1):46–52.
Khan MA, Sohail I, Habib M. Auditing the caesarean section rate by Robson’s ten group classification system at Tertiary Care Hospital. Prof Med J 2020;27(4):700–6.
Abubeker FA, Gashawbeza B, Gebre TM, Wondafrash M, Teklu AM, Degu D, et al. Analysis of caesarean section rates using Robson ten group classification system in a tertiary teaching hospital, Addis Ababa, Ethiopia: a cross-sectional study. BMC Pregnancy Childbirth 2020;20(1):767.
Parveen R, Khakwani M, Naz A, Bhatti R. Analysis of Caesarean Sections using Robson’s Ten Group Classification System. Pak J Med Sci 2021;37(2):567–71.
Gilani S, Mazhar SB, Zafar M, Mazhar T. The modified Robson criteria for caesarean section audit at mother and child health center Pakistan Institute of Medical Sciences Islamabad. J Pak Med Assoc 2020;70(2):299–303.
Gu J, Karmakar-Hore S, Hogan ME, Azzam HM, Barrett JF, Brown A, et al. Examining caesarean section rates in Canada using the modified Robson classification. J Obstet Gynaecol Can 2020;42(6):757–65.
Ansari A, Baqai S, Imran R. An audit of caesarean section rate using modified Robson criteria at a tertiary care hospital. J Coll Physicians Surg Pak 2019;29(8):768–70.
Shankar P, Madhu J, Raju V. A clinical study on the analysis of caesarean section rates using Robson's ten group classification in a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol 2019;8(2):488–92.
Senanayake H, Piccoli M, Valente EP, Businelli C, Mohamed R, Fernando R, et al. Implementation of the WHO manual for Robson classification: an example from Sri Lanka using a local database for developing quality improvement recommendations. BMJ Open 2019;9(2):e027317.
Fatima SS, Zeb L, Shafqat T, Qazi Q. Analysis of caesarean section rate according to Robson classification criteria: a cross sectional study in a tertiary care hospital. Am J Health Med Nurs Pract 2022;7(5):18–27.
Bolognani CV, Reis LB, Dias A, Calderon ID. Robson 10-groups classification system to access C-section in two public hospitals of the Federal District/Brazil. PLoS One 2018;13(2):e0192997.
Pravina P, Ranjana R, Goel N. Caesarean Audit Using Robson Classification at a Tertiary Care Center in Bihar: A Retrospective Study. Cureus 2022;14(3):e23133.
Vila-Candel R, Martín A, Escuriet R, Castro-Sánchez E, Soriano-Vidal FJ. Analysis of caesarean section rates using the robson classification system at a university hospital in Spain. Int J Environ Res Public Health 2020;17(5):1575.
Souza JP, Betran AP, Dumont A, De Mucio B, Gibbs Pickens CM, Deneux‐Tharaux C, et al. A global reference for caesarean section rates (C‐Model): a multicountry cross‐sectional study. BJOG 2016;123(3):427–36.
WHO. Robson classification: implementation manual 2017.
Copyright (c) 2023 Saira Nazeer, Mehmona Rehman, Saba Khan, Sadia Sadiq, Khadija Bano
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.