Analysis of Caesarean Section Rates Using the Robson Classification System at a University Hospital in Spain

Abstract

Background: The WHO recommends the use of the Robson ten-group classification system (RTGCS) as an effective monitoring and analysis tool to assess the use of caesarean sections (CS). The present study aimed to conduct an analysis of births using the RTGCS in La Ribera University Hospital over nine years and to assess the levels and trends of CS births. Methods: Retrospective study between January 1, 2010, and December 31, 2018. All eligible women were allocated in RTGCS to determine the absolute and relative contribution made by each group to the overall CS rate; linear regression and weighted least squares regression analysis were used to analyze trends over time. The risk of CS of women with induced versus spontaneous onset of labor was calculated with an odds ratio (OR) with a 95% CI. Results: 16,506 women gave birth during the study period, 19% of them by CS. Overall, 20.4% of women were in group 1 (nulliparous, singleton cephalic, term, spontaneous labor), 29.4% in group 2 (nulliparous, singleton cephalic, term, induced labor or caesarean before labor), and 12.8% in group 4 (multiparous, singleton cephalic, term, induced or caesarean delivery before labor) made the most significant contributions to the overall rate of CS; Conclusions: In our study, Robson Groups 1, 2, and 4, were identified as the main contributors to the hospital's overall CS rate. The RTGCS provides an easy way of collecting information about the CS rate, is a valuable clinical method that allows standardized comparison of data, and time point, and identifies the groups driving changes in CS rates. justification do not reduce maternal or infant death rates if carried out at a rate higher than 10%-15% [2]. The unjustified, excessive use of clinical procedures can lead to an ever-increasing therapeutic cascade of avoidable interventions [3] and become life-threatening in the present or future pregnancies for both the women and children [4]. The worldwide rise in CS rates has become a growing public health concern and a cause for debate due to potential maternal and perinatal risks, cost issues, and inequity in access [5].There is a high degree of variability in the reported crude rates of CS performed in different countries and regions, and there are often even significant differences between hospitals within a single region. The highest caesarean rates are observed in the Dominican Republic (56.4%), Brazil (55.6%), and Egypt (51.8%), with Africa (7.3%) showing the lowest proportion of these procedures [1]. In most European countries, the rates are about 25% to 35% [5]. In Spain, the average CS rate reported across the 17 autonomous communities, the governing entities independently responsible for health care [6] and for deploying health resources to serve the needs of their local populations, was found to be 24.5% in 2015 [7,8]. However, due to the decentralized structure of the health system, there is no nationally established system to monitor the use of caesarean procedures.Achieving reductions in maternal and infant morbidity and morta...

Obstetric Violence in Spain (Part II): Interventionism and Medicalization during Birth

“…The WHO indicates that its ideal rate must range between 10% and 15% [ 27 ]. According to the present study, Spain easily exceeds the recommended rate, and similar data also appear in other reports or studies [ 15 , 28 ].…”

A 10 year comparative study of caesarean deliveries using the Robson 10 group classification system in a university hospital in Austria

“…This rate is consistent with previous reports [9,17,18]. It has been suggested by Robson that a ratio between group 1 and 2 lower than 2:1 suggests a higher incidence of induction and CD before labour [19].…”

Classification of caesarean section based on Robson ten group classification system in our hospital

“…A similar study was conducted in Peru from 2000 to 2010 and it was observed that group I and III along with Group V and VII were the major contributor to the increasing rate of CS. 15 There was another study conducted in Spain in the year 2010 and result was similar to our study with Group I (20.4%) and Group II (29.4%) as a second major contributor to increasing CS rate after group V. 16 Based on our study and the results of other studies across the world we believe 3 major concerns need to be addressed to limit the increasing CS rate. The first and the most critical is that every hospital should adopt clear guideline regarding induction of labour.…”