Utilizing the Robson 10-Group Classification System as an Audit Tool in Assessing the Soaring Caesarean Section Rates in Ibadan, Nigeria

Abstract

Background: The caesarean section (CS) is the most common operation performed globally with increased incidence worldwide. Aim and Objectives: Using the Robson 10-Group Classification System (RTGCS), we aimed to identify women who were the main contributors to the high CS rate (CSR) over a 3-year period at a foremost tertiary health facility. Settings: This study was conducted at the Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria. Materials and Methods: This study is a retrospective study of all women who delivered by CS at the University College Hospital, Ibadan, Nigeria from January 2017 to December 2019. Data were obtained using a structured proforma and women were categorized according to the RTGCS. Data were analysed using SPSS version 21. Descriptive statistics (frequency, percentage, mean) carried out were presented in tables. Results: The CSR was 46.9%. Women in Group 5 (parous women >37 weeks with previous CS and a single foetus in cephalic presentation), Group 1 (nulliparous women >37 weeks with a single foetus in cephalic presentation and spontaneous labour), and Group 10 (women <37 weeks with a single foetus in cephalic presentation) were major contributors to the CSR, with 30.9%, 17.7%, and 13.7%, respectively. Stillbirth rates were highest in Groups 10 (30.3%), 3 (24.4%), and 8 (16.8%). Apgar score <7 at the 5th minute was highest in Groups 5 (29.7%), 10 (17%), and 1 (16.6%). Conclusion: In a bid to reduce caesarean deliveries, efforts should focus on increasing the proportion of vaginal deliveries in these identified groups, especially in women with a history of one CS.

Analysis of caesarean sections with the Robson’s ten group classification system

“…This is similar to the study done by Bello et al where 62.6% women were multiparous. 10 Most of the women (69.51%) in our study were between 37-42 weeks of gestational age similar to Abubeker et al and Bello et al, where the majority of women belonged to the group more than 37 weeks gestational age. 9,10 In contrast in the study done by Parveen et al in 2021 showed majority of women belonging to less than 37 weeks of gestational age.…”

“…10 Most of the women (69.51%) in our study were between 37-42 weeks of gestational age similar to Abubeker et al and Bello et al, where the majority of women belonged to the group more than 37 weeks gestational age. 9,10 In contrast in the study done by Parveen et al in 2021 showed majority of women belonging to less than 37 weeks of gestational age. 11 In the present study 39 (47.57%) women had history of one previous section, 6 (7.31%) had history of two previous sections.…”

“…Bello and associates showed 62.4% of women with no previous section and only 37.6 women with history of previous section. 10 Similarly in a study done by Parveen et al in 2021 showed majority of the women (64.7%) had no history of previous section. 11 These studies are in contrast to our study.…”

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

“…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).…”

“…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.…”