Search

Abstract Background The Robson Ten Groups Classification System (RTGCS) is increasingly used to assess, monitor, and compare caesarean section (CS) rates within and between healthcare facilities. We evaluated the major contributing groups to the CS rate at Gulu Regional Referral Hospital (GRRH) in Northern Uganda using the RTGCS. Methods We conducted a retrospective analysis of all deliveries from June 2019 through July 2020 at GRRH, Gulu city, Uganda. We reviewed files of mothers and collected data on sociodemographic and obstetric variables. The outcome variables were Robson Ten Groups (1–10) based on parity, gestational age, foetal presentation, number of foetuses, the onset of labour, parity and lie, and history of CS. Results We reviewed medical records of 3,183 deliveries, with a mean age of 24.6 ± 5.7 years. The overall CS rate was 13.4% (n = 427). Most participants were in RTGCS groups 3 (43.3%, n = 185) and 1 (29.2%, n = 88). The most common indication for CS was prolonged labour (41.0%, n = 175), followed by foetal distress (19.9%, n = 85) and contracted pelvis (13.6%, n = 58). Conclusion Our study showed that GRRH patients had a low-risk obstetric population dominated by mothers in groups 3 and 1, which could explain the low overall CS rate of 13.4%. However, the rates of CS among low-risk populations are alarmingly high, and this is likely to cause an increase in CS rates in the future. We recommend group-specific interventions through CS auditing to lower group-specific CS rates.

Background: The Robson Ten Groups Classification System (RTGCS) is increasingly used to assess, monitor, and compare caesarean section (CS) rates within and between healthcare facilities. We evaluated the major contributing groups to the CS rate at Gulu Regional Referral Hospital (GRRH) in Northern Uganda using the RTGCS. Methods: We conducted a retrospective analysis of all deliveries from June 2019 through July 2020 at GRRH, Gulu city, Uganda. We reviewed files of mothers and collected data on sociodemographic and obstetric variables. The outcome variables were Robson Ten Groups (1–10) based on parity, gestational age, foetal presentation, number of foetuses, the onset of labour, parity and lie, and history of CS. Results: We reviewed medical records of 3,183 deliveries, with a mean age of 24.6 ± 5.7 years. The overall CS rate was 13.4% (n = 427). Most participants were in RTGCS groups 3 (43.3%, n = 185) and 1 (29.2%, n = 88). The most common indication for CS was prolonged labour (41.0%, n = 175), followed by foetal distress (19.9%, n = 85) and contracted pelvis (13.6%, n = 58). Conclusion: Our study showed that GRRH patients had a low-risk obstetric population dominated by mothers in groups 3 and 1, which could explain the low overall CS rate of 13.4%. However, the rates of CS among low-risk populations are alarmingly high, and this is likely to cause an increase in CS rates in the future. We recommend group-specific interventions through CS auditing to lower group-specific CS rates. [ABSTRACT FROM AUTHOR]

Susan Nantume,1 Eric Murungi Baluku,2 Doris Kwesiga,1 Peter Waiswa1 1College of Health Science, Makerere University, Kampala, Uganda; 2Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, UgandaCorrespondence: Eric Murungi Baluku, Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda, Tel +256773595259, Email murungieric978@gmail.comIntroduction: The number of caesarean section (CS) continues to rise worldwide. CS can improve outcomes in infants and mothers. However, if used improperly, the potential harm can outweigh the potential benefits.Aim: The study was to determine the factors associated with high cesarean section rates at Mengo Hospital.Methods: This cross-sectional study used a mixed-method approach that included a retrospective review of 1276 casebooks using the Robson Ten Group Classification System (RTGCS) for births that occurred at Mengo Hospital in December 2018, January, and February 2019. Questionnaire was used for data collection from 200 mothers on second day after birth from 24th May to 19th July 2019. Eight key informants were interviewed within the same period. Quantitative data were analyzed using STATA V.14, thematic analysis for qualitative data. Univariate, bivariate, and multivariate analyses were performed to determine the association between predisposing factors and outcome variables using chi-square and modified Poisson.Results: Caesarean section rate (CSR) from casebooks was 49% and 64% from the primary data. Group 5(Previous CS, single cephalic, > 37 weeks) had (35.4%) to the total number of cesarean deliveries, followed by Group 1 (Nulliparous, single cesarean deliveries, > 37 weeks in spontaneous labour), with 18.4%. Group 3 (ultiparous (excluding previous CS), single cephalic, > 37 weeks of spontaneous labor) with (13.7%). The common indications from casebooks were a previous scar (32%), obstructed labor (18%), and previous scar (97.6%). Presence of an obstetric indication, influence of husband, friends, relatives, and mother’s desire for a CS were closely associated with caesarean delivery. Mothers said that occurrence of CS was due to health workers reducing the stress of monitoring labour and financial benefits from CS deliveries by the hospital.Conclusion: Repeat CS made the highest CSR contribution; therefore, strategies to reduce the frequency of the procedure should include avoiding medically unnecessary primary CS and encouraging vaginal birth after previous CS where applicable.Keywords: Robson Ten Group Classification System, cesarean section, previous scar

Background: The rising cesarean section (CS) rate is a global concern and World Health Organization in 2015 has proposed the use of Robson-10 group classification system as a standard for assessing and monitoring CS both within and across the healthcare facilities. Objective: The objective is to analyze the CSs performed in a teaching hospital using Robson 10-group classification system. Methodology: The present cross-sectional study was done over a period of 1 year from May 2017 to April 2018. All eligible women delivered in JIPMER, a tertiary care referral center during the study period were classified as per Robson Ten-Group classification system. Caesarean delivery rates were reported. The relative and absolute contribution to CS rates in each groups were calculated. Epi data V.3.1 was used for data analysis. Results: Among 16,863 women delivered during the study, the CS rate was 21.4%. The three common indications for CS overall were fetal distress, nonprogress of labor, and cephalopelvic disproportion. Group 1 (nulliparous, singleton, term cephalic, spontaneous labor) was the largest size followed by group 2 (nulliparous, singleton, term cephalic, induced labor) with 25% and 16.9%, respectively. The maximum contribution of CS was by group 5 (multiparous women, singleton, term cephalic, previous uterine scar) followed by group 2 with 34.9% and 18.9%, respectively. Conclusion: Robson group 5, 2, and 1 were the major contributions to CS in our hospital. Further studies are needed to study the appropriateness of indications for CS especially in groups 2 and 1 as they are the future group 5.

Background: The rising cesarean section (CS) rate is a global concern and World Health Organization in 2015 has proposed the use of Robson-10 group classification system as a standard for assessing and monitoring CS both within and across the healthcare facilities. Objective: The objective is to analyze the CSs performed in a teaching hospital using Robson 10-group classification system. Methodology: The present cross-sectional study was done over a period of 1 year from May 2017 to April 2018. All eligible women delivered in JIPMER, a tertiary care referral center during the study period were classified as per Robson Ten-Group classification system. Caesarean delivery rates were reported. The relative and absolute contribution to CS rates in each groups were calculated. Epi data V.3.1 was used for data analysis. Results: Among 16,863 women delivered during the study, the CS rate was 21.4%. The three common indications for CS overall were fetal distress, nonprogress of labor, and cephalopelvic disproportion. Group 1 (nulliparous, singleton, term cephalic, spontaneous labor) was the largest size followed by group 2 (nulliparous, singleton, term cephalic, induced labor) with 25% and 16.9%, respectively. The maximum contribution of CS was by group 5 (multiparous women, singleton, term cephalic, previous uterine scar) followed by group 2 with 34.9% and 18.9%, respectively. Conclusion: Robson group 5, 2, and 1 were the major contributions to CS in our hospital. Further studies are needed to study the appropriateness of indications for CS especially in groups 2 and 1 as they are the future group 5. [ABSTRACT FROM AUTHOR]

Objectives: Cesarean delivery rates have increased remarkably and cause a major public health concern. This study aims to evaluate the feasibility of using the Robson Ten Group Classification System (TGCS) for cesarean delivery (CD) indications at institutional level. Materials and Methods: Database of all women delivering at Cipto Mangunkusumo Hospital, Jakarta, Indonesia were analayzed. The CD rates overall and in each Robson group were calculated, as was the contribution of each group to the overall CD rate. In addition, the CD indications in each group were analyzed. Results: Approximately almost half (48.04%) of women delivered by CS in our study. Groups 10 was the largest groups representing 27.82% of the obstetric population. The second and third largest were group 3 and 1, which represents 18.00% and 17.34%, respectively. The highest relatively contribution of CS rate were group 10, 1, and 3 with the percentage of 28.24%, 17.59%, and 15.19%; contributively. Conclusion: The TGCS can be applied at institutional level. It helps in planning strategies for specific subgroups of women to reduce CS rate and improve outcomes.

Background and objective: The aim of this study was to analyze cesarean section (CS) rates using Robson Ten Group Classification System (TGCS) and to identify the main contributors to the overall CS rate in Lithuania. Materials and methods: A prospective cross-sectional study was carried out. All women who delivered between January 1 and December 31, 2012, in Lithuania were classified using the TGCS. The CS rates overall and in each Robson group were calculated, as was the contribution of each group to the overall CS rate. Results: The CS rate was 26.4% (6697 among 25,373 deliveries) in 2012. Nulliparous women with single cephalic full-term pregnancy in spontaneous labor (Group 1) or who underwent induction of labor or prelabor CS (Group 2) and multiparous women with a previous CS (Group 5) were the greatest contributors (67.7%) to the overall CS rate. In addition, significant variation of CS rates between different institutions was observed, especially in women with single cephalic full-term pregnancy without previous CS (Groups 1–4), showing big differences in obstetric care across country. Conclusions: Women in Groups 1, 2 and 5 were the largest contributions to the overall CS rate in Lithuania. It seems that efforts to reduce the overall CS rate should be directed on increasing vaginal birth after CS and reducing CS rates in nulliparous women with single cephalic full-term pregnancy (Groups 1 and 2).

Introduction: Midwifery-led care is recognised as the best choice of maternity care for low-risk women. Robson's Ten Group Classification System (TGCS) is an internationally recognised audit tool, however there is no midwifery-led service presenting their statistics in this way. The objective of this study was to analyse caesarean section rates for the women attending midwifery-led care at the National Maternity Hospital Dublin, Ireland, using the Robson TGCS., Methods: This is a retrospective study of electronic records for a total of 1097 women who were booked to attend the community midwife team in the National Maternity Hospital, during 2016 and 2017., Results: The rate of caesarean section in low-risk nulliparous women (Robson Group 1) was under 6%, without affecting the perinatal outcome. The induction rate in nulliparous women (Group 2) was 36%, less than the national average the cesarean rates were quadruple in this group., Conclusions: Low-risk women who attend midwifery-led services, have a low caesarean section rate in this study. This was achieved with continuity of care, good antenatal preparation, and support throughout labour and birth by a dedicated team of midwives. Outcomes can only be truly compared if we use the same criteria to measure them. The TGCS demonstrates the effectiveness of midwifery-led care., Competing Interests: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2020 Hanahoe M. et al.)

Objective: To analyse the current situation of caesarean section in Palestine using the Robson Ten Group Classification System (TGCS)., Design: A population-based birth cohort study., Setting: Obstetrical departments in three governmental hospitals in Gaza., Participants: All women (18 908) who gave birth between 1 January 2016 and 30 April 2017., Methods: The contributions of each group to the study population and to the overall rate of caesarean section were calculated, as well as the rate of caesarean section in each TGCS group. Differences in proportions between study hospitals were assessed by χ 2 test., Main Outcome Measures: The main outcome was the contributions of each group to the overall caesarean section rate., Results: The overall rate of caesarean section was 22.9% (4337 of 18 908), ranging from 20.6% in hospital 1 to 24.6% in hospital 3. The largest contributors to the overall caesarean section rate were multiparous women with single cephalic full-term pregnancy who had undergone at least one caesarean section (group 5, 42.6%), women with multiple pregnancies (group 8, 11.6%) and those with single cephalic preterm labour (group 10, 8.1%). Statistically significant differences in caesarean section rates between the study hospitals were observed in group 1 (nulliparous women with single cephalic full-term pregnancy and spontaneous labour), group 4 (multiparous with single cephalic full-term pregnancy with induced labour or prelabour caesarean section), group 5 (multiparous with single cephalic full-term pregnancy with previous caesarean section) and in group 7 (multiparous with breech presentation)., Conclusion: Women in groups 5, 8 and 10 were the largest contributors to the overall caesarean section rate in the study hospitals. Efforts to reduce the differences in obstetrical care between hospitals need to be directed towards increasing the proportion of vaginal births after caesarean section and by reducing primary caesarean section in multiple pregnancies and preterm labour., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Objective: The aim of this study was to analyze cesarean section (CS) rates using Robson Ten Group Classification System (TGCS) and to identify the main contributors to the overall CS rate in Lithuania., Materials and Methods: A prospective cross-sectional study was carried out. All women who delivered between January 1 and December 31, 2012, in Lithuania were classified using the TGCS. The CS rates overall and in each Robson group were calculated, as was the contribution of each group to the overall CS rate., Results: The CS rate was 26.4% (6697 among 25,373 deliveries) in 2012. Nulliparous women with single cephalic full-term pregnancy in spontaneous labor (Group 1) or who underwent induction of labor or prelabor CS (Group 2) and multiparous women with a previous CS (Group 5) were the greatest contributors (67.7%) to the overall CS rate. In addition, significant variation of CS rates between different institutions was observed, especially in women with single cephalic full-term pregnancy without previous CS (Groups 1-4), showing big differences in obstetric care across country., Conclusions: Women in Groups 1, 2 and 5 were the largest contributions to the overall CS rate in Lithuania. It seems that efforts to reduce the overall CS rate should be directed on increasing vaginal birth after CS and reducing CS rates in nulliparous women with single cephalic full-term pregnancy (Groups 1 and 2)., (Copyright © 2015 Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)