Robson classification of caesarean births: implications for reducing caesarean section rate in a private tertiary hospital in Nigeria

Abstract

Background Caesarean section (CS) is a potentially lifesaving obstetric procedure. However, there are concerns about the rising CS rate in many countries of the world including Nigeria. The Ten-Group Robson classification system is presently recommended as an effective monitoring tool for comparing CS rates and identifying target groups for intervention aimed at reducing the rates. The aim of this study was to evaluate the cesarean section rate and the groups with the highest risk of CS at the obstetric unit of Babcock University Teaching Hospital (BUTH), using the Robson classification system. Methods A cross-sectional study involving 447 women who gave birth at the obstetric unit of BUTH between August 2020 and February 2022. Relevant information was retrieved from the delivery records of the study participants. Data were analyzed using the IBM-SPSS Statistics for Windows version 23.0 (IBM Corp., Armonk, NY, USA). Results The overall CS rate was 51.2%. Multiparous women with previous CS, single, cephalic, term (group 5); nulliparous women, single cephalic, term, with induced labour or pre-labour CS (group 2); women with preterm single cephalic, term (group 10); and single cephalic term multiparous women in spontaneous labour (group 3) were the largest contributors to CS rate accounting for 34.5%, 14.0%, 12.6%, and 10.0% respectively. The commonest indication for CS was previous CS (87; 38.0%), followed by poor progress in labour (24; 10.5%). Conclusions The CS rate in BUTH is high and Robson groups 5, 2 10 and 3 were the major contributors to this high rate. Interventions directed at reducing the first CS by improving management of spontaneous and induced labours; and strengthening clinical practice around encouraging vaginal birth after CS will have the most significant effect on reducing CS rate.

Towards Optimizing Caesarean Section: Robson Ten Group Analysis of Caesarean Section and It’s Determinants in a Tertiary Hospital in South-South, Nigeria

“…The groups making the largest contributions to CS rate in this study; 3, 10, 5 and 1 consecutively, is similar in composition to results from previous Nigerian studies done in Ibadan (Bello and Agboola, 2022), Ilisan-Remo (Akadiri et al, 2023) and Makurdi (Ochejele et al, 2021), and from studies done in some other African countries (Mbaye et al, 2015;Tura et al, 2018;Makhanya et al, 2015), Bangladesh (Begum, 2019), andBrazil (Nakamura-Pereira et al, 2016). It is closest in both composition and order to the study done in Ethiopia (Tura et al, 2018) that reported 3, 5 and 1.…”

“…We compared the 48.4% CS rate from this study with that from other public and forprofit private hospital-based studies within Nigeria and across countries and regions that analysed CS using Robson classification system. Within Nigeria, studies in Ibadan (Bello and Agboola, 2022), Ilisan-Remo (Akadiri et al, 2023) and Makurdi (Ochejele et al, 2021) recorded CS rates of 46.9%, 51.2% and 24.3% respectively. In other African countries, hospital-level CS rates varied from as low as 18.2% in Senegal (Mbaye et al, 2015), up to 25.7% in Ethiopia (Tura et al, 2018) and 42.4% in South Africa (Makhanya et al, 2015).…”

“…The highest rates from this comparison were more from private hospital settings in Bangladesh, Brazil and Nigeria. This is largely because threshold for CSs for medically unjustifiable indications is more likely to be low in private hospitals, largely for social reasons, profit and fear of litigation that may attend adverse perinatal outcome (Akadiri et al, 2023). The variation in hospital-level CS rates within and across hospital settings and regions also reflects differences in obstetric case mix.…”

“…Using the Robson classification system, groups of parturients who contribute most and least to CS rates can be identified, and specific group-focused interventions relevant for each health care facility can be adopted. Analysis of hospital-level CS rate on the basis of the Robson classification system is already being carried out in hospitals in Nigeria (Ochejele et al, 2021;Bello and Agboola, 2022;Okonta et al, 2022;Akadiri et al, 2023) and other countries. Country (Kelly et al, 2013;Nakamura-Pereira et al, 2016;Kacerauskiene et al, 2017) and regional (Zeitlin et al, 2021) data is also being published.…”

Investigating the risk factors for isthmocele development after cesarean delivery

“… 4 The reasons for the rising CD rates are still subject to debate, with some authors suggesting fear of litigation, changing maternal characteristics, electronic fetal monitoring, and changing professional practice styles, whereas others suggest sociocultural and economic factors. 5 , 6 , 7 Healthcare providers can take preventive measures to minimize CD risks and complications, such as infection, excessive bleeding, organ injury, anesthesia reactions, blood clots, and prolonged recovery. It is also important for patients to be informed of possible long-term effects on future pregnancies, such as issues with placental implantation or uterine rupture risks.…”