Evaluation of cesarean delivery rates at three university hospital labor units using the Robson classification system

Abstract

Objective To analyze the frequency of cesarean delivery using the Robson 10‐group classification. Methods A multicenter retrospective cohort study was conducted at three university hospital labor units in the Slovak Republic. The medical records of all women who gave birth at these centers from January 1 to December 31, 2017, were assessed. Results In all, 1437 of 3361 (42.8%), 729 of 2795 (26.1%), and 303 of 2080 (14.6%) births recorded at the three centers during the current study period were by cesarean delivery. Among the nulliparous term singleton vertex deliveries (Robson group 1 and 2), the frequency of cesarean delivery at the three centers was 613 of 1653 (37.1%), 278 of 1389 (20.0%), and 91 of 898 (10.1%). Among term multiparas with one fetus in a cephalic position and at least one previous cesarean delivery (Robson group 5), the frequency of cesarean delivery at the three centers was 405 of 418 (96.9%), 261 of 343 (76.1%), and 55 of 115 (47.8%). Conclusion Analysis of the frequency of cesarean delivery by Robson classification could help to identify possibilities for safely decreasing cesarean delivery rates in the clinic. Robson groups 1, 2, and 5 were the most modifiable groups.

Gestational Risk as a Determining Factor for Cesarean Section according to the Robson Classification Groups

“…The HUSM presented results similar to the ones recorded by Tapia et al (2016) 17 in Latin America and by Yadav et al (2016) 18 in India when it started to perform all childbirths, not just the high-risk ones. 17 18 Therefore, the comparison between Robson Classification results and data available in the literature allowed observing that the frequency of pregnant women in each group was associated with population type, as it was also reported by Zahumensky et al (2019), 14 who compared three Slovak centers presenting different healthcare profiles: one tertiary center with neonatal intensive care unit (NICU), intensive care unit (ICU) and two other centers that only treated pregnant women with gestational age > 32 weeks. The aforementioned study has found differences in the most recurrent Robson groups in each service, as well as cesarean section rate variations from service to service.…”

“…This outcome highlighted the influence of healthcare profile on the delivery and cesarean rates in each service. 14 Based on results of the present study, most women belonged to group 5 during data collection at the HUSMthis group accounted for $ 25% of childbirths. This finding confirms the fact that the incidence of previous cesarean sections was the main indication for cesarean section in the investigated service.…”

“…Strategies focused on reducing the frequency of cesarean sections should encourage women to avoid clinically unnecessary primary cesarean sections, correctly manage labor in women with history of cesarean delivery, perform the external cephalic version for pelvic presentations, as well as vaginal delivery of twins with the first fetus in cephalic presentation, and reduce iatrogenic preterm delivery. 13,14 Another important effort focused on reducing cesarean delivery rates lies on labor induction when childbirth is indicated. According to a Portuguese study, the cesarean section rate resulting from labor induction reached 20.9%; this number corresponded to 23% of the total number of cesarean sections.…”

“…9,10 Given the clarity, objectivity and easy application of this classification method, it has been used to survey, monitor and compare cesarean section rates within and between institutions; it also allows analyzing these data, as well as identifying safe alternatives to help reducing cesarean section rates. [11][12][13][14] The present study has analyzed childbirths performed at the Hospital Universitário de Santa Maria (HUSM, in the Portuguese acronym), as well as classified them based on the Robson Classification, to help better understanding the real situation of cesarean section indications and the profile of childbirths performed in the investigated institution. The results may collaborate with the creation of strategies to reduce the high cesarean rates in Brazilian institutions.…”

“… 9 10 Given the clarity, objectivity and easy application of this classification method, it has been used to survey, monitor and compare cesarean section rates within and between institutions; it also allows analyzing these data, as well as identifying safe alternatives to help reducing cesarean section rates. 11 12 13 14 …”