Implementation of the Robson Classification in Greece: A Retrospective Cross-Sectional Study

Abstract

Cesarean sections have become the most commonly performed operations around the world. The World Health Organization recommended the use of the Robson classification system as a universal standard to establish a joint control system in healthcare facilities. The aim of this study was to implement the Robson classification for the first time in Greece to identify trends in cesarean births and examine the groups of women who are the main contributors to the increasing rates. Moreover, the indicators for cesarean sections will be evaluated as per the Robson classification. In the sample analysis, we included the records of 8572 women giving birth in one private health facility in Greece. A total of 8572 women gave birth during the study period, of which 5224 (60.9%) were cesarean section births and 3348 (39.1%) were vaginal births. In our study, according to the Robson classification, the largest contributors to the overall CS rate were as follows: (a) nulliparous women with a single cephalic term pregnancy, who were either labor induced or delivered by cesarean section before labor—Group 2 (34.6%); (b) multiparous women with a single cephalic term pregnancy and at least one previous cesarean section—Group 5 (30.7%); (c) women with a single cephalic preterm pregnancy—Group 10 (11.7%); (d) women with multiple pregnancies—Group 8 (7.0%). Our study is expected to assist policymakers in Greece in planning further interventions for each subgroup of women in order to reduce the overall CS rate and unnecessary CSs.

Can the Day of the Week and the Time of Birth Predict the Mode of Delivery According to Robson Classification?

“…Our earlier study showed that cephalopelvic disproportion and previous cesarean section are the most frequent indications for a cesarean section [25]. Several studies have associated high cesarean section rates with non-clinical factors.…”

“…The present study is part of a wider research protocol on the implementation of the Robson classification in the Greek classification setting. The methods of the research study have been previously published and are summarized here as follows [25]. This is a single-center retrospective study conducted between January and December 2019.…”

Fostering Excellence in Obstetrical Surgery

“…1,2 Classification of CD clinical factors is important as it allows for an understanding and comparison of different classification rates and audit results (Table 2). [9][10][11][12] Trial of labor after caesarean delivery (TOLAC) and vaginal delivery after caesarean delivery (VBAC) 3,4 are similar terms for the option of waiting for the onset of spontaneous labor and the opportunity for a possible vaginal delivery, following a previous CD delivery. Important counselling issues are related to the indication for the previous caesarean delivery, the patient motivation for a vaginal delivery, the limited opportunity for oxytocin use in labor and the 1% risk for uterine rupture during labor, with maternal and neonatal morbidity and possible neonatal mortality.…”

“…The ten Robson categories (Table 2) are mutually exclusive, totally inclusive, and can be applied prospectively, with each pregnant person that is admitted for delivery can be classified immediately, using a few variables that are generally routinely recorded. [9][10][11][12]50,51 The Robson classification system helps with institution-specific monitoring and auditing but offers a standardised comparison method that can be used between institutions, countries, and timepoints. 50 The Robson classification system (Table 2) has had some modifications to the original Robson groups.…”

“…50 The Robson classification system (Table 2) has had some modifications to the original Robson groups. [9][10][11][12]51 The modification has added a subclassification to categories 5-10 for pregnant people that have had a caesarean delivery but defines when, after spontaneous onset of labour, after induction of labour, or before the onset of labour: 5. Previous caesarean section, singleton, cephalic, ≥37 weeks' gestation (5a; 5b; 5c).…”