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Hassan L, Betran AP, Woodbury L, Uzma Q, Gholbzouri K, Thom E, Reza TE. Implementing the Robson Classification for caesarean sections in Pakistan: experience, challenges, and lessons learned. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 30:100479. [PMID: 39399389 PMCID: PMC11466671 DOI: 10.1016/j.lansea.2024.100479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 07/10/2024] [Accepted: 08/29/2024] [Indexed: 10/15/2024]
Abstract
The Robson Classification System is recognised as a first step for optimising the use of caesarean section and as a strategy for continuous quality improvement in maternal and newborn health. This Viewpoint provides a detailed account of the strategy adopted and lessons learned from a collaborative initiative to institutionalise the Robson Classification into Pakistan's health system. We developed a training package which emphasised capacity building of senior clinicians to act as master trainers. We also developed a mobile application for data collection and analysis. Training workshops took place in 2020 in a selection of public sector, tertiary-level, teaching hospitals from across the country and data was collected on all births in participating hospitals' obstetric units for a full year. Pakistan is poised for scale-up with the Robson Classification embedded in 57% of Pakistan's public, tertiary, teaching hospitals. A core group of master trainers is positioned in every province, and a robust dataset is available. However, integration into any health system cannot be thought of as a finite project. It requires government commitment, training and an ongoing process with built-in data quality assurance and feedback to clinicians.
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Affiliation(s)
- Lubna Hassan
- Women's Health Intervention and Development Initiative, Islamabad, Pakistan
| | - Ana Pilar Betran
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Lauren Woodbury
- Women's Health Intervention and Development Initiative, Islamabad, Pakistan
| | - Qudsia Uzma
- World Health Organization Country Office for Pakistan, Pakistan
| | - Karima Gholbzouri
- World Health Organization Regional Office for Eastern Mediterranean, Monazamet El Seha El Alamia Street, Extension of Abdel Razak El Sanhouri Street, P.O. Box 7608, Nasr City, Cairo, 11371, Egypt
| | - Ellen Thom
- World Health Organization Country Office for Pakistan, Pakistan
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Arata M, Boyle S, Sgorbissa B, Tognon F, John-Cole V, Orsi M, Caracciolo C, Saccardi C, Manenti F, Putoto G, K Kamara A, Betran AP. Caesarean sections, indications and outcomes: a cross-sectional study using the Robson classification in a tertiary hospital in Sierra Leone. BMJ Open 2024; 14:e081143. [PMID: 39231555 PMCID: PMC11409385 DOI: 10.1136/bmjopen-2023-081143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2024] Open
Abstract
OBJECTIVE WHO recommends the use of the Robson's 'Ten Groups Classification' for monitoring and assessing caesarean section (CS) rates. The aim of this study was to investigate the rates, indications and outcomes of CS using Robson classification in a tertiary hospital in Sierra Leone. DESIGN Cross-sectional study. SETTING Princess Christian Maternity Hospital (PCMH), Freetown, Sierra Leone. PARTICIPANTS All women who gave birth in PCMH from 1 October 2020 to 31 January 2021. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome: CS rate by Robson group. SECONDARY OUTCOMES indications for CS and the newborn outcomes for each Robson group. RESULTS 1998 women gave birth during the study period and 992 CS were performed, with a CS rate of 49.6%. Perinatal mortality was 7.8% and maternal mortality accounted for 0.5%. Two-thirds of the women entered labour spontaneously and were considered at low risk (groups 1 and 3). CS rates in these groups were very high (43% group 1 and 33% group 3) with adverse outcomes (perinatal mortality, respectively, 4.1% and 6%). Dystocia was the leading indication for CS accounting for about two-thirds of the CS in groups 1 and 3. Almost all women with a previous CS underwent CS again (95%). The group of women who give birth before term (group 10) represents 5% of the population with high CS rate (50%) mainly because of emergency conditions. CONCLUSION Our data reveals a notably high CS rate, particularly among low-risk groups according to the Robson classification. Interpretation must consider PCMH as a referral hospital within an extremely low-resourced healthcare system, centralising all the complicated deliveries from a vast catchment area. Further research is required to assess the impact of referred obstetrical complications on the CS rate and the feasibility of implementing measures to improve the management of women with dystocia and previous CS.
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Affiliation(s)
- Matteo Arata
- Department of Women and Children's Health, University of Padua, Padova, Italy
| | - Sonia Boyle
- Department of Obstetrics and Gynecology Princess Christian Maternity Hospital (PCMH), University of Sierra Leone, Freetown, Sierra Leone
| | - Beatrice Sgorbissa
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | - Valerie John-Cole
- Department of Obstetrics and Gynecology Princess Christian Maternity Hospital (PCMH), University of Sierra Leone, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Michele Orsi
- Mangiagalli Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Carlo Saccardi
- Department of Women and Children's Health, University of Padua, Padova, Italy
| | | | | | - Abibatu K Kamara
- Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area, Sierra Leone
| | - Ana Pilar Betran
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Ssennuni E, Bongomin F, Akuma E, Lukujja K, Kule H, Opiro K, Awor S, Arwinyo B, Ojara S, Opee J, Jackline A, Jackline A, Pebolo PF. Caesarean section rates in a tertiary teaching hospital in northern Uganda: a retrospective analysis using the robson ten group classification system. BMC Pregnancy Childbirth 2024; 24:489. [PMID: 39033127 PMCID: PMC11264903 DOI: 10.1186/s12884-024-06689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND The Robson Ten Groups Classification System (RTGCS) is increasingly used to assess, monitor, and compare caesarean section (CS) rates within and between healthcare facilities. We evaluated the major contributing groups to the CS rate at Gulu Regional Referral Hospital (GRRH) in Northern Uganda using the RTGCS. METHODS We conducted a retrospective analysis of all deliveries from June 2019 through July 2020 at GRRH, Gulu city, Uganda. We reviewed files of mothers and collected data on sociodemographic and obstetric variables. The outcome variables were Robson Ten Groups (1-10) based on parity, gestational age, foetal presentation, number of foetuses, the onset of labour, parity and lie, and history of CS. RESULTS We reviewed medical records of 3,183 deliveries, with a mean age of 24.6 ± 5.7 years. The overall CS rate was 13.4% (n = 427). Most participants were in RTGCS groups 3 (43.3%, n = 185) and 1 (29.2%, n = 88). The most common indication for CS was prolonged labour (41.0%, n = 175), followed by foetal distress (19.9%, n = 85) and contracted pelvis (13.6%, n = 58). CONCLUSION Our study showed that GRRH patients had a low-risk obstetric population dominated by mothers in groups 3 and 1, which could explain the low overall CS rate of 13.4%. However, the rates of CS among low-risk populations are alarmingly high, and this is likely to cause an increase in CS rates in the future. We recommend group-specific interventions through CS auditing to lower group-specific CS rates.
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Affiliation(s)
- Eric Ssennuni
- Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, City, Uganda
| | - Felix Bongomin
- Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, City, Uganda
| | - Elvis Akuma
- Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, City, Uganda
| | - Kizito Lukujja
- Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, City, Uganda
| | - Henry Kule
- Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, City, Uganda
| | - Keneth Opiro
- Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, City, Uganda
| | - Silvia Awor
- Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, City, Uganda
| | - Baifa Arwinyo
- Department of Obstetrics and Gynaecology, Gulu Regional Referral Hospital, Gulu City, Uganda
| | - Sande Ojara
- Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, City, Uganda
| | - Jimmyy Opee
- Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, City, Uganda
| | - Ayikoru Jackline
- Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, City, Uganda
| | - Akello Jackline
- College of Health Sciences, Makerere University, Makerere, Kampala, Uganda
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Pasko DN, McGee P, Grobman WA, Bailit JL, Reddy UM, Wapner RJ, Varner MW, Thorp JM, Caritis SN, Prasad M, Saade GR, Sorokin Y, Rouse DJ, Tolosa JE. Comparison of Cesarean Deliveries in a Multicenter U.S. Cohort Using the 10-Group Classification System. Am J Perinatol 2024; 41:1223-1231. [PMID: 35668654 PMCID: PMC9718892 DOI: 10.1055/s-0042-1748527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE We sought to (1) use the Robson 10-Group Classification System (TGCS), which classifies deliveries into 10 mutually exclusive groups, to characterize the groups that are primary contributors to cesarean delivery frequencies, (2) describe inter-hospital variations in cesarean delivery frequencies, and (3) evaluate the contribution of patient characteristics by TGCS group to hospital variation in cesarean delivery frequencies. STUDY DESIGN This was a secondary analysis of an observational cohort of 115,502 deliveries from 25 hospitals between 2008 and 2011. The TGCS was applied to the cohort and each hospital. We identified and compared the TGCS groups with the greatest relative contributions to cohort and hospital cesarean delivery frequencies. We assessed variation in hospital cesarean deliveries attributable to patient characteristics within TGCS groups using hierarchical logistic regression. RESULTS A total of 115,211 patients were classifiable in the TGCS (99.7%). The cohort cesarean delivery frequency was 31.4% (hospital range: 19.1-39.3%). Term singletons in vertex presentation with a prior cesarean delivery (group 5) were the greatest relative contributor to cohort (34.8%) and hospital cesarean delivery frequencies (median: 33.6%; range: 23.8-45.5%). Nulliparous term singletons in vertex (NTSV) presentation (groups 1 [spontaneous labor] and 2 [induced or absent labor]: 28.9%), term singletons in vertex presentation with a prior cesarean delivery (group 5: 34.8%), and preterm singletons in vertex presentation (group 10: 9.8%) contributed to 73.2% of the relative cesarean delivery frequency for the cohort and were correlated with hospital cesarean delivery frequencies (Spearman's rho = 0.96). Differences in patient characteristics accounted for 34.1% of hospital-level cesarean delivery variation in group 2. CONCLUSION The TGCS highlights the contribution of NTSV presentation to cesarean delivery frequencies and the impact of patient characteristics on hospital-level variation in cesarean deliveries among nulliparous patients with induced or absent labor. KEY POINTS · We report on the cesarean delivery frequencies in a multicenter U.S. COHORT . · NTSV gestations (groups 1 and 2) are a primary driver of cesarean deliveries.. · Patient characteristics contributed most to hospital variation in cesarean deliveries in group 2..
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Affiliation(s)
- Daniel N Pasko
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paula McGee
- The George Washington University Biostatistics Center, Washington, District of Columbia
| | - William A Grobman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Jennifer L Bailit
- Department of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio
| | - Uma M Reddy
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Michael W Varner
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - John M Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Steve N Caritis
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mona Prasad
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - George R Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Yoram Sorokin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
| | - Dwight J Rouse
- Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
| | - Jorge E Tolosa
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
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Shylla A, Teferici D, Shpuza A, Xhetani X, Roshi E. Factors Affecting Elective and Non-elective Cesarean Sections: A Multinomial Regression Analysis Using Robson's Classification in a Southeast European Country. Cureus 2024; 16:e62038. [PMID: 38989387 PMCID: PMC11234161 DOI: 10.7759/cureus.62038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Albania, a middle-income Southeast European country, is experiencing an increase in cesarean section rates. This study aims to analyze cesarean section practices in Albania using the Robson classification to identify patterns and provide insights into elective and non-elective cesarean trends. METHODS This retrospective cohort study was conducted at the University Hospital of Obstetrics and Gynecology "Koco Gliozheni" in Albania, a leading tertiary hospital, from January to May 2023, involving 5,315 consecutive women who delivered during this period, including both live births and stillbirths, with a gestational age minimum of 28 weeks to align with standards of viability. We defined a function to systematically evaluate each case based on multiple criteria: parity, fetal presentation, onset of labor, previous deliveries, number of fetuses, and gestational age according to the Robson classification. Multinomial multiple regression was used to estimate the relationship between each of the above-mentioned variables and the likelihood of each type of cesarean delivery compared to normal births. RESULTS The participants' mean age was 28.2 years (59.6% <30 years vs. 40.4% ≥30 years), while gestational age varied (12.1% before 37 weeks, the majority (72.3%) between 37 and 40 weeks, and 15.6% > 40 weeks). In elective cesarean sections, maternal age (odds ratio (OR) = 1.06) and gestational age (OR = 1.13) were associated with increased odds, with women with previous cesarean deliveries showing significantly higher odds (OR = 20.6), breech position (OR = 15.7), and multiple pregnancies elevating odds (OR = 7.3), whereas in non-elective cesarean sections, similar associations were observed with slightly different odds ratios which were maternal age (OR = 1.07), gestational age (OR = 1.16), previous cesarean delivery (OR = 6.3), breech position (OR = 8.5), and multiple pregnancies (OR = 5.1). Significant disparities in cesarean section rates were observed across various groups, with rates ranging from as low as 0.74% in Group 1 to as high as 89.24% in Group 5, and notable contributions from Group 2 with a rate of 69.95% and Group 6 with a rate of 81.29%. CONCLUSION In conclusion, this study emphasizes the significance of factors such as maternal age, gestational age, previous cesarean deliveries, fetal presentation, number of fetuses, and multiple pregnancies in impacting the rates of elective, non-elective, and overall cesarean sections in Albania, highlighting the need for targeted strategies to improve maternal and fetal health outcomes.
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Affiliation(s)
- Arjan Shylla
- Department of Obstetrics and Gynecology, University Hospital of Obstetrics and Gynecology "Koco Gliozheni", Tirane, ALB
| | - Daniela Teferici
- Department of Cardiology and Cardiac Surgery, University Hospital Center "Mother Theresa", Tirane, ALB
| | - Aldo Shpuza
- Department of Public Health, University of Medicine, Tirane, ALB
| | | | - Enver Roshi
- Department of Public Health, University of Medicine, Tirane, ALB
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Węgrzynowska M, Baranowska B, Sys D, Kajdy A, Karzel K, Bączek G, Szlendak B, Tataj-Puzyna U. Using Robson classification to analyze cesarean section and induction rates in relation to changes in the standards of perinatal care in one hospital in Poland. Birth 2024; 51:384-394. [PMID: 37915248 DOI: 10.1111/birt.12794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Poland has one of the highest cesarean birth (CB) rates in Europe. For this study, we used the Robson Ten-Group Classification System (TGCS) to analyze trends in the induction and CB rates in one hospital in Poland over a period of 11 years. We compare these trends with changes in National Legislative and Medical Guidelines introduced during this time that were aimed at lowering rates of unnecessary medical interventions. METHODS We conducted a retrospective study including all births after 24 weeks' gestation between 2010 and 2020 from one tertiary hospital (n = 66,716 births). After the deletion of records with missing data, 66,678 births were included in the analysis. All births were classified according to the Robson TGCS. The size, CB rate, and contribution of each group for every year were calculated. Linear regression analyses were used to analyze trends over time. RESULTS The total CB rate varied from 29.6% to 33.0% during the study period, with a linear increase of 0.045 percentage points annually (R2 = 0.021; F(1) = 0.189; p = 0.674). This study was considerably lower than the total CB rate for Poland, which rose from 33.9% in 2010 to 45.1% in 2020, increasing at a rate of 1.13 percentage points per year (R2 = 0.93; F(1) = 61.88; p < 0.001). Induction rates among both nulliparous (R1 + R2) and multiparous (R3 + R4) women at term also increased. Study groups R5 (previous cesarean birth), R2 (nulliparous in induced or prelabor cesarean delivery), and R1 (nulliparous women at term with single cephalic pregnancy in spontaneous labor) were the highest contributors to the overall CB rate. The greatest decrease in the CB rate was detected in group R5b (more than one previous CB). None of the groups showed statistically significant increases in CB rates over the study period. CONCLUSIONS The CB rate in the hospital where the study was conducted was considerably lower than the total CB rate in Poland. When compared with countries with similar CB rates, group R2b (women with nulliparous, prelabor cesarean birth) in our study was considerably larger. More comparisons across different hospital settings in Poland are needed. However, as hospitals are not encouraged to routinely collect the data needed to construct TGCS, such comparisons are very difficult to conduct.
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Affiliation(s)
- Maria Węgrzynowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Dorota Sys
- Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Anna Kajdy
- Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Grażyna Bączek
- Department of Obstetrics and Gynecology Didactics, Medical University of Warsaw, Warsaw, Poland
| | - Beata Szlendak
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Urszula Tataj-Puzyna
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
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Choudhary D, Saxena N, Gupta V. Trend analysis of caesarean sections using modified Robson's classification in a teaching institution in Uttarakhand. J Family Med Prim Care 2024; 13:2278-2282. [PMID: 39027835 PMCID: PMC11254037 DOI: 10.4103/jfmpc.jfmpc_1288_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 07/20/2024] Open
Abstract
Background Globally, the rising caesarean section (CS) rate is of great concern as it is associated with increased maternal morbidity and mortality in subsequent pregnancies. It is essential to reanalyze the CS trend and curb the rising menace using a standardized uniform auditing system. This study aimed to analyze and evaluate the trend of CS using Modified Robson's Ten Group classification system (RTGCS) in a teaching institution in Uttarakhand. Methodology This cross-sectional study from October 2022 to March 2023 included 260 women undergoing elective or emergency CS. Data on maternal demographics, obstetrics, labour, and fetal outcomes were recorded. Indications for CS were analyzed using modified RTGCS. Results The overall CS rate for the study period at our hospital was 31.4%. The major contributors to CS were Group 2 (21.5%), Group 10 (21.5%), and Group 5 (20.7%), while Group 6 and Group 8 contributed 10% and 7.6%, respectively. Group 9 had the least share (1%) in the study population. The two main indications for which CS was performed were prior Lower Section Caesarean Section (LSCS) and fetal distress, contributing to 24.6% and 19.2%, respectively. CS for breech presentation was done in 16% of the total cases. Conclusion Modified RTGCS is an easy and effective method for auditing CS, preventing unnecessary procedures, and improving maternal care. Its implementation is crucial in addressing the increasing prevalence of CS and ensuring better maternal and fetal outcomes.
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Affiliation(s)
- Deepti Choudhary
- Department of Obstetrics and Gynaecology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - Namrata Saxena
- Department of Obstetrics and Gynaecology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - Vineeta Gupta
- Department of Obstetrics and Gynaecology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
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Abuduxike G, Cali S, Vaizoğlu SA, Aşut Ö, Çavuş M, Olgu M, Çavuş SN, Arkut M, Idehen BO, Almezghwi HAS, Asswayeh HMA, Abawu JJ, Hossain MJ, Almawali NA. An Analysis of the Mode of Delivery, Risk Factors, and Subgroups with High Caesarean Birth Rates Using Robson Classification System. Matern Child Health J 2024; 28:667-678. [PMID: 37840109 DOI: 10.1007/s10995-023-03783-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE We aimed to understand the utilization of the mode of delivery and related risk factors. Further aimed to apply the Robson classification system to evaluate the data quality and analyze the CS rates in subgroups. METHODS We conducted a retrospective descriptive study by reviewing the medical records of all women who delivered at the State Hospital in 2019. A proforma was developed for extracting data from patient records. All women with six obstetric parameters were categorized into Robson groups to determine the absolute and relative contributions of each group to the overall CS rate. RESULTS Of 797 deliveries, 401 (50.2%) were CSs. Being older, being Turkish Cypriot, having preterm births, previous CS, multiple fetuses, and having breech or transverse fetal presentations were related to having higher risks of CS. The most common medical indication for CSs (52.3%) was a history of previous CSs. Robson Group 5 contributed the most (50.7%) to the overall CS rate, with the highest absolute contribution of 21.8%. Group 10 and Group 8 were the second and third highest contributors to the overall CS rate, with relative contributions of 25.3% and 9.0%, respectively. CONCLUSIONS Findings revealed the substandard quality of obstetric data and a noticeably high overall CS rate. The top priority should be given to improving the quality of medical records. It underscored the necessity of implementing the Robson classification system as a standard clinical practice to enhance data quality, which helps to effectively evaluate and monitor the CS rates in obstetric populations.
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Affiliation(s)
- Gulifeiya Abuduxike
- Department of Public Health, Faculty of Medicine, Near East University, Near East Boulevard, 99138, Nicosia, Northern Cyprus.
| | - Sanda Cali
- Department of Public Health, Faculty of Medicine, Near East University, Near East Boulevard, 99138, Nicosia, Northern Cyprus
| | - Songül Acar Vaizoğlu
- Department of Public Health, Faculty of Medicine, Near East University, Near East Boulevard, 99138, Nicosia, Northern Cyprus
| | - Özen Aşut
- Department of Public Health, Faculty of Medicine, Near East University, Near East Boulevard, 99138, Nicosia, Northern Cyprus
| | - Mahmut Çavuş
- Dr. Burhan Nalbantoğlu State Hospital Obstetrics and Gynaecology Department, Nicosia, Northern Cyprus
| | - Musa Olgu
- Dr. Burhan Nalbantoğlu State Hospital Obstetrics and Gynaecology Department, Nicosia, Northern Cyprus
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Gantt DM, Misselwitz B, Boos V, Reitter A. Errors in the classification of pregnant women according to Robson ten-group classification system. Eur J Obstet Gynecol Reprod Biol 2024; 295:53-57. [PMID: 38335585 DOI: 10.1016/j.ejogrb.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/25/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES The Robson Ten-Group Classification System (TGCS) is widely used as a classification system for perinatal analyses such as Caesarean section (CS) rates. In Germany, standardised data sets on deliveries are classified by quality assurance institutions using the TGCS. This observational study aims to evaluate potential errors in the TCGS classification of deliveries. STUDY DESIGN Manual TGCS classification of all 1370 deliveries in an obstetric unit in 2018 and comparison with semi-automatic TGCS classifications of the quality assurance institution. RESULTS In the manual classification, 259 out of 1370 births (18.9 %) were assigned to a different Robson group than in the semi-automatic classification. The proportions of births by Robson group were significantly different in TGCS group 1 (32.2 % vs. 37.6 %, p = 0.0034) and group 2 (18.4 % vs. 14.4 %, p = 0.0053). Concordance between manual and semi-automatic classifications ranged from 59.5 % in group 2 to 100.0 % in groups 6, 7, 8, and 9. The most frequent mismatches were for the parameters "onset of labour" in 184 cases (13.4 %), "parity" in 42 cases (3.1 %) and "previous uterine scars" in 23 cases (1.7 %). In the manual classification, there were significant differences in the CS rate in group 1 (7.9 % vs. 2.5 %, p < 0.0001), group 2 (30.2 % vs. 48.2 %, p < 0.0001), and group 4 (14.1 % vs. 37.4 %, p = 0.0004), compared to the semi-automatic classification. CONCLUSIONS Due to incorrect data entry and unclear definitions of criteria, quality assurance data in obstetric databases may contain a relevant proportion of errors, which could influence statistics with TGCS in context of CS rates in international comparisons.
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Affiliation(s)
| | - Björn Misselwitz
- Federal State Consortium of Quality Assurance Hesse (Landesarbeitsgemeinschaft Qualitätssicherung Hessen, LAGQH), Frankfurter Str. 10, 65760 Eschborn, Germany.
| | - Vinzenz Boos
- Newborn Research, Department of Neonatology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland.
| | - Anke Reitter
- Goethe-University Frankfurt, Theodor-Stern-Kai, 60596 Frankfurt am Main, Germany; Department of Obstetrics, Hospital Zollikerberg, Trichtenhauserstrasse 20, 8125 Zollikerberg, Switzerland.
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Shtainmetz N, Tesler R, Sharon C, Korn L. Optimizing caesarean section use and feasibility of implementing the Robson classification system: Perspectives of healthcare providers and policymakers. SAGE Open Med 2024; 12:20503121241237447. [PMID: 38533202 PMCID: PMC10964469 DOI: 10.1177/20503121241237447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/15/2024] [Indexed: 03/28/2024] Open
Abstract
Introduction and Objective In recent decades, caesarean section rates have increased dramatically worldwide and the reasons for this trend are not fully understood. This continuing trend has raised public health concerns regarding higher maternal and perinatal risks, high costs, healthcare efficiency, and inequality of services. The current study aimed to explore the perspectives and insights of healthcare providers and policymakers in the Israeli health system regarding the factors that drive caesarean section rates and the readiness and feasibility of implementing the Robson Ten Group Classification System for the first time. Methods Semi-structured interviews were conducted (n = 12) with purposefully selected healthcare providers and policymakers in Israel. Data was analysed inductively using a thematic analysis approach. Results The findings reflected the "changing landscape" in childbirth practices and attitudes that contributes to the rising caesarean section rate, including childbirth at older ages, birth planning, and a transition toward a more collaborative decision-making approach to childbirth. The participants emphasized the lack of a standardized classification or consistent data monitoring of caesarean section in the Israeli health system. Additionally, enablers to implement the Robson Ten Group Classification System in Israel (ease of use, data collection and recording, and the allocation of resources and personnel), as well as barriers (concerns over workload, limited resources, budget implications, and technological complexity), were found. Conclusions This study revealed the multifaceted factors shaping caesarean section rates within Israel and underscored the perceived need for evidence-based monitoring and informed decision-making in healthcare practices. Our findings support the conclusion that empirical evidence and clear data are crucial for effective caesarean section use and are currently lacking in Israeli hospitals. Thus, it is recommended to adopt a globally standardized, accepted, and effective tool-the Robson Ten Group Classification System-to accommodate the "changing landscape" in alignment with evolving medical and societal dynamics, which consequently will assist in optimizing caesarean section use.
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Affiliation(s)
- Noa Shtainmetz
- Department of Health Systems Management, School of Health Sciences, Ariel University, Ariel, Israel
| | - Riki Tesler
- Department of Health Systems Management, School of Health Sciences, Ariel University, Ariel, Israel
| | - Cochava Sharon
- The Academic College of Law and Science, Hod Hasharon, Israel
| | - Liat Korn
- Department of Health Systems Management, School of Health Sciences, Ariel University, Ariel, Israel
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11
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Zaigham M, Varallo J, Thangaratinam S, Nicholson W, H. A. Visser G. Global disparities in caesarean section rates: Why indication-based metrics are needed. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002877. [PMID: 38319901 PMCID: PMC10846695 DOI: 10.1371/journal.pgph.0002877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Affiliation(s)
- Mehreen Zaigham
- Obstetrics and Gynaecology, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Wanda Nicholson
- Department of Prevention and Community Health, George Washington Milken Institute of Public Health and the Department of Obstetrics and Gynaecology, George Washington School of Medicine, Washington, DC, United States of America
| | - Gerard H. A. Visser
- Department of Obstetrics, University Medical Center, Utrecht, The Netherlands
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12
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Parasiliti M, Vidiri A, Perelli F, Scambia G, Lanzone A, Cavaliere AF. Cesarean section rate: navigating the gap between WHO recommended range and current obstetrical challenges. J Matern Fetal Neonatal Med 2023; 36:2284112. [PMID: 37989541 DOI: 10.1080/14767058.2023.2284112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
The cesarean section (CS) rate is very heterogeneous all over the world, reflecting the differences in the access to healthcare services. In higher-income countries, changes observed in the obstetrical population brought to an increased rate of cesarean section for maternal request. Besides, clinicians are facing an increasing number of induction of labor, with the consequent risk of CS if the management is inappropriate. Analyzing the rate of primary CS, the interpretation of intrapartum CTG and a tailored management of labor are also red flags that must be considered. In this optic, the implementation of obstetrics training and simulation programs and the improvement of clinical protocols with the latest evidence can lead to the reduction of unnecessary CS.
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Affiliation(s)
- Marco Parasiliti
- Department of Gynecology and Obstetrics, ASST Crema - Ospedale Maggiore, Crema, Italy
| | - Annalisa Vidiri
- Department of Gynecology and Obstetrics, Isola Tiberina Hospital - Gemelli Isola, Rome, Italy
| | - Federica Perelli
- Division of Gynaecology and Obstetrics, Santa Maria Annunziata Hospital, USL Toscana Centro, Florence, Italy
| | - Giovanni Scambia
- Department of Science of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Lanzone
- Department of Science of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Anna Franca Cavaliere
- Department of Gynecology and Obstetrics, Isola Tiberina Hospital - Gemelli Isola, Rome, Italy
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Rezaei Ghamsari S, Taeidi E, Darsareh F, Mehrnoush V. Analysis of Cesarean Section Rates in a Public Tertiary Hospital During Teaching and Non-teaching Periods Using the Robson Ten Group Classification System. Cureus 2023; 15:e43838. [PMID: 37736452 PMCID: PMC10509773 DOI: 10.7759/cureus.43838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION The rising cesarean section (CS) rate is a global concern. One of the hospital characteristics that may explain the variation in CS among hospitals is hospital teaching status. This study aims to assess the rate of CS in a tertiary hospital during the teaching and non-teaching periods and to conduct an analysis using the Robson ten-group classification system. METHODS This study is a retrospective cohort that assessed pregnant mothers who gave birth at a tertiary hospital in Bandar Abbas. The study population was divided into two groups: those who gave birth during the hospital's teaching period (November 1st, 2019 to October 30th, 2020) and those who gave birth after that (November 1st, 2020 to October 30th, 2021). The primary outcome was the rate of CS according to Robson's classification system. The secondary outcome was the contributions of each group of Robson to the overall CS rate. Data were extracted by trained collectors from the "Iranian Maternal and Neonatal Network (IMaN Net)," a valid national system, using electronic patient records. RESULTS Of the total number of births (8382), 62.9 % occurred during the teaching period and 37.1 % during the non-teaching period. A 7% increase in CS was observed during the teaching period of the hospital compared to the non-teaching period (p<0.01). CS rate in Robson groups 1,2,4,7, and 10 differs significantly between teaching and non-teaching periods. According to the findings, Groups 5, 10, and 2 were the three most significant contributors to overall CS in our hospital during the study period. CONCLUSION The efforts to reduce the overall CS rate should be focused on groups 2,5, and 10 of Robson.
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Affiliation(s)
- Sepideh Rezaei Ghamsari
- Department of Midwifery and Reproductive Health, Tehran University of Medical Sciences, Tehran, IRN
| | - Elham Taeidi
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IRN
| | - Fatemeh Darsareh
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IRN
| | - Vahid Mehrnoush
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IRN
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De Jesus M, Sullivan N, Hopman W, Martinez A, Glenn PD, Msopa S, Milligan B, Doney N, Howell W, Sellers K, Jackson MC. Examining the Role of Quality of Institutionalized Healthcare on Maternal Mortality in the Dominican Republic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6413. [PMID: 37510645 PMCID: PMC10379411 DOI: 10.3390/ijerph20146413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/23/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
The main study objective was to determine the extent to which the quality of institutionalized healthcare, sociodemographic factors of obstetric patients, and institutional factors affect maternal mortality in the Dominican Republic. COM-Poisson distribution and the Pearson correlation coefficient were used to determine the relationship of predictor factors (i.e., hospital bed rate, vaginal birth rate, teenage mother birth rate, single mother birth rate, unemployment rate, infant mortality rate, and sex of child rate) in influencing maternal mortality rate. The factors hospital bed rate, teenage mother birth rate, and unemployment rate were not correlated with maternal mortality. Maternal mortality increased as vaginal birth rates and infant death rates increased whereas it decreased as single mother birth rates increased. Further research to explore alternate response variables, such as maternal near-misses or severe maternal morbidity is warranted. Additionally, the link found between infant death and maternal mortality presents an opportunity for collaboration among medical specialists to develop multi-faceted solutions to combat adverse maternal and infant health outcomes in the DR.
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Affiliation(s)
- Maria De Jesus
- School of International Service & Center on Health, Risk, and Society, American University, Washington, DC 20016, USA
| | - Nora Sullivan
- School of International Service & Center on Health, Risk, and Society, American University, Washington, DC 20016, USA
| | - William Hopman
- Data Science, Purdue University, West Lafayette, IN 47907, USA
| | - Alex Martinez
- Statistics and Data Science, The University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Paul David Glenn
- Agricultural and Environmental Sciences, McGill University, Montreal, QC H3A 0G4, Canada
| | - Saviour Msopa
- Mathematics and Statistics, American University, Washington, DC 20016, USA
| | | | - Noah Doney
- Mathematics, University of Maryland College Park, College Park, MD 20742, USA
| | - William Howell
- Mathematics and Statistics, American University, Washington, DC 20016, USA
| | - Kimberly Sellers
- Mathematics and Statistics, Georgetown University, Washington, DC 20057, USA
| | - Monica C Jackson
- Mathematics and Statistics, American University, Washington, DC 20016, USA
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Piva VMR, Voget V, Nucci LB. Cesarean section rates according to the Robson Classification and its association with adequacy levels of prenatal care: a cross-sectional hospital-based study in Brazil. BMC Pregnancy Childbirth 2023; 23:455. [PMID: 37340447 DOI: 10.1186/s12884-023-05768-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND The rate of Cesarean section (CS) deliveries has been increasing worldwide for decades. Brazil exhibits high rates of patient-requested CS deliveries. Prenatal care is essential for reducing and preventing maternal and child morbidity and mortality, ensuring women's health and well-being. The aim of this study was to verify the association between the level of prenatal care, as measured by the Kotelchuck (APNCU - Adequacy of the prenatal care utilization) index and CS rates. METHODS We conducted a cross-sectional study based on data from routine hospital digital records and federal public health system databases (2014-2017). We performed descriptive analyses, prepared Robson Classification Report tables, and estimated the CS rate for the relevant Robson groups across distinct levels of prenatal care. Our analysis also considered the payment source for each childbirth - either public healthcare or private health insurers - and maternal sociodemographic data. RESULTS CS rate by level of access to prenatal care was 80.0% for no care, 45.2% for inadequate, 44.2% for intermediate, 43.0% for adequate, and 50.5% for the adequate plus category. No statistically significant associations were found between the adequacy of prenatal care and the rate of cesarean sections in any of the most relevant Robson groups, across both public (n = 7,359) and private healthcare (n = 1,551) deliveries. CONCLUSION Access to prenatal care, according to the trimester in which prenatal care was initiated and the number of prenatal visits, was not associated with the cesarean section rate, suggesting that factors that assess the quality of prenatal care, not simply adequacy of access, should be investigated.
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Affiliation(s)
- Veridiana Monteiro Ramos Piva
- Health Sciences Post Graduate Program, Faculty of Medicine, School of Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, S/N - Jd. Ipaussurama, Campinas - São Paulo, CEP: 13060-904, Brazil.
| | - Verena Voget
- Faculty of Medicine, School of Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, S/N - Jd. Ipaussurama, Campinas - São Paulo, CEP: 13060-904, Brazil
| | - Luciana Bertoldi Nucci
- Health Sciences Post Graduate Program, Faculty of Medicine, School of Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, S/N - Jd. Ipaussurama, Campinas - São Paulo, CEP: 13060-904, Brazil
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Tappis H, Lak R, Alhilfi R, Zangana AH, Wadi F, Hipgrave D, Ibrahim S. Quality of maternal and newborn health care at private hospitals in Iraq: a cross-sectional study. BMC Pregnancy Childbirth 2023; 23:331. [PMID: 37161362 PMCID: PMC10170688 DOI: 10.1186/s12884-023-05678-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/03/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Approximately 25% of facility births take place in private health facilities. Recent national studies of maternal and newborn health (MNH) service availability and quality have focused solely on the status of public sector facilities, leaving a striking gap in information on the quality of maternal and newborn care services. METHODS A rapid cross-sectional assessment was conducted in November 2022 to assess the quality of MNH services at private hospitals in Iraq. Multi-stage sampling was used to select 15% of the country's 164 private hospitals. Assessment tools included a facility assessment checklist, a structured health worker interview tool, and a structured client exit interview tool. Data collection was conducted using KoboToolbox software on Android tablets, and analysis conducted using SPSS v28. RESULTS All hospitals visited provided MNH services and had skilled personnel present or on-call 24 h/day, 7 days/week. Most births (88%) documented between January and June 2022 were cesarean births. Findings indicate that nearly all hospitals have the human resources, equipment, medicines and supplies necessary for quality antenatal, intrapartum and early essential newborn care, and many are also equipped with special units and resources needed to care for small and sick babies. However, while resources are in place for basic and advanced care, there are gaps in knowledge and practice of high-impact interventions that require few or no resources to perform, including skin-to-skin thermal care and support for early initiation of breastfeeding. Person-centered maternity care scores suggest that private hospitals offer a positive experience of care for all clients, however there is room for improvement in provider-client communication. CONCLUSIONS This assessment highlights the need for deeper dives into factors that underly decisions about how and where to give birth, and both understanding and practice of early essential newborn care and pre-discharge examinations and counseling at private healthcare facilities in Iraq. Engaging private health facility staff in efforts to monitor and improve the quality of maternal and newborn care, with a focus on early essential newborn care and provider-client communication for all clients, will ensure that women and newborns benefit from the best care possible with available resources.
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Affiliation(s)
- Hannah Tappis
- Department of International Health, Johns Hopkins Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Rebaz Lak
- Kurdistan Higher Council of Medical Specialties, Erbil, Iraq
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Wong KT, Niles KM. Mise à jour technique N° 436 : Classification des césariennes au Canada : Critères de Robson modifiés. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:342-345.e1. [PMID: 37244697 DOI: 10.1016/j.jogc.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIF Décrire et promouvoir l'utilisation d'un système de classification universel de la césarienne au Canada. POPULATION CIBLE Les femmes enceintes devant subir une césarienne. BéNéFICES, RISQUES ET COûTS: L'utilisation d'un système de classification normalisé de la césarienne permet de comparer les taux de césariennes et tendances aux échelles locale, régionale, nationale et internationale. Le système inclusif et simple à mettre en œuvre repose sur des bases de données existantes. DONNéES PROBANTES: La revue exhaustive de la littérature a été mise à jour pour tenir compte des articles publiés jusqu'en avril 2022; les articles ont été répertoriés à partir de mots clés et de termes MeSH (cesarean section, classification, taxonomy, nomenclature, terminology) dans les bases de données PubMed-Medline et Embase. Seuls les résultats de revues systématiques, d'essais cliniques randomisés, d'essais cliniques et d'études observationnelles ont été retenus. D'autres publications ont été répertoriées par consultation des références d'articles intégraux pertinents. La littérature grise a été examinée en recherchant sur les sites Web d'organismes de santé. MéTHODES DE VALIDATION: Les auteures ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et conditionnelles [faibles]). Le conseil d'administration de la SOGC a approuvé la version définitive aux fins de publication. PROFESSIONNELS CONCERNéS: Fournisseurs de soins obstétricaux, administrateurs des services de santé, épidémiologistes. RECOMMANDATIONS
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Wong KT, Niles KM. Technical Update No. 436: Classification of Cesarean Deliveries in Canada: The Modified Robson Criteria. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:338-341.e1. [PMID: 37244696 DOI: 10.1016/j.jogc.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To describe and advocate for the use of a common classification system for cesarean delivery in Canada. TARGET POPULATION Pregnant individuals undergoing cesarean delivery. BENEFITS, HARMS, COSTS Use of a standardized classification system for cesarean delivery allows for local, regional, national, and international comparison of cesarean delivery rates and trends. The system is inclusive and simple to implement, based on existing databases. EVIDENCE A comprehensive literature review was updated to April 2022 with medical subject headings (MeSH) and keywords (cesarean section, classification, taxonomy, nomenclature, terminology) in MEDLINE/PubMed and Embase databases. Results were restricted to systematic reviews, randomized controlled trials and clinical trials, and observational studies. Additional literature was identified by backward citation tracking using relevant full-text articles. The grey literature was reviewed by searching websites of health agencies. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendation using the Grade of Recommendations, Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretation of strong and conditional [weak] recommendations).The Board of the SOGC approved the final draft for publication. INTENDED AUDIENCE Obstetric care providers, health care administrators, epidemiologists. RECOMMENDATIONS
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Abdallah W, Abi Tayeh G, Kesrouani A, Nassar M, Finan R, Mansour F, Attieh E, Suidan J, Bou Saba C, El Kassis N, Yaghi N, Aouad N, Atallah D. The rate of cesarean delivery changes after internal audit based on the Robson Ten Group Classification System in Lebanon. Int J Gynaecol Obstet 2023; 161:314-319. [PMID: 36479965 DOI: 10.1002/ijgo.14610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/06/2022] [Accepted: 10/28/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the efficiency of the Robson classification as an internal clinical audit and feedback of the high rate of cesarean delivery at Hotel Dieu de France, a tertiary referral hospital. METHODS A pre-post study was conducted, with a retrospective approach in 2018 and 2019, identified as the pre-period (before the implementation of the Robson classification), and with a prospective approach in 2020 and 2021, labeled the post-period. RESULTS The total number of deliveries during the study period was 2560; 1305 patients were included in the pre-period and 1255 patients delivered in the post-period. No significant differences between the two groups were found. No significant difference was found in the overall rate of cesarean delivery between the first and second periods (57.86% vs 56.72%; P = 0.2). However, a significant decrease in the absolute contribution of groups 3 and 4 (multiparous women without a previous uterine scar with a single cephalic pregnancy, ≥37 weeks of gestation, with spontaneous labor or induced labor) in the overall rate of cesarean delivery was remarked (P = 0.02 and 0.01, respectively). CONCLUSION The Robson classification seems to be appropriate to monitor and audit the rate of cesarean delivery, but not sufficient to decrease the rate and change the practice.
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Affiliation(s)
- Wael Abdallah
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Georges Abi Tayeh
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Assaad Kesrouani
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Malek Nassar
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Ramzi Finan
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Fersan Mansour
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Elie Attieh
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Joe Suidan
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Camille Bou Saba
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Nadine El Kassis
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Nancy Yaghi
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Norma Aouad
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - David Atallah
- Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
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Gartner DR, Debbink MP, Brooks JL, Margerison CE. Inequalities in cesarean births between American Indian & Alaska Native people and White people. Health Serv Res 2023; 58:291-302. [PMID: 36573019 PMCID: PMC10012218 DOI: 10.1111/1475-6773.14122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To explore population-level American Indian & Alaska Native-White inequalities in cesarean birth incidence after accounting for differences in cesarean indication, age, and other individual-level risk factors. DATA SOURCES AND STUDY SETTING We used birth certificate data inclusive of all live births within the United States between January 1 and December 31, 2017. STUDY DESIGN We calculated propensity score weights that simultaneously incorporate age, cesarean indication, and clinical and obstetric risk factors to estimate the American Indian and Alaska Native-White inequality. DATA COLLECTION/EXTRACTION METHODS Births to individuals identified as American Indian, Alaska Native, or White, and residing in one of the 50 US states or the District of Columbia were included. Births were excluded if missing maternal race/ethnicity or any other covariate. PRINCIPAL FINDINGS After weighing the American Indian and Alaska Native obstetric population to be comparable to the distribution of cesarean indication, age, and clinical and obstetric risk factors of the White population, the cesarean incidence among American Indian and Alaska Natives increased to 33.4% (95% CI: 32.0-34.8), 3.2 percentage points (95% CI: 1.8-4.7) higher than the observed White incidence. After adjustment, cesarean birth incidence remained higher and increased in magnitude among American Indian and Alaska Natives in Robson groups 1 (low risk, primary), 6 (nulliparous, breech presentation), and 9 (transverse/oblique lie). CONCLUSIONS The unadjusted lower cesarean birth incidence observed among American Indian and Alaska Native individuals compared to White individuals may be related to their younger mean age at birth. After adjusting for this demographic difference, we demonstrate that American Indian and Alaska Native individuals undergo cesarean birth more frequently than White individuals with similar risk profiles, particularly within the low-risk Robson group 1 and those with non-cephalic presentations (Robson groups 6 and 9). Racism and bias in clinical decision making, structural racism, colonialism, or other unidentified factors may contribute to this inequality.
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Affiliation(s)
- Danielle R. Gartner
- Department of Epidemiology & Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMichiganUSA
| | - Michelle P. Debbink
- Department of Obstetrics and GynecologyUniversity of Utah Health and Intermountain HealthcareSalt Lake CityUtahUSA
| | - Jada L. Brooks
- School of NursingUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Claire E. Margerison
- Department of Epidemiology & Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMichiganUSA
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Giaxi P, Gourounti K, Vivilaki V, Zdanis P, Galanos A, Antsaklis A, Lykeridou A. Implementation of the Robson Classification in Greece: A Retrospective Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11060908. [PMID: 36981564 PMCID: PMC10048284 DOI: 10.3390/healthcare11060908] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/08/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
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.
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Affiliation(s)
- Paraskevi Giaxi
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Kleanthi Gourounti
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Victoria Vivilaki
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Panagiotis Zdanis
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Antonis Galanos
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, 15784 Athens, Greece
| | - Aris Antsaklis
- IASO, General Maternity and Gynecology Clinic, 15123 Athens, Greece
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22
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Obstetrical outcomes of labor with and without analgesia in Robson classification groups 1 and 2a: a single-center retrospective study. J Anesth 2023; 37:39-48. [PMID: 36251094 DOI: 10.1007/s00540-022-03125-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/10/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE This study aimed to elucidate the effects of neuraxial analgesia on labor in women classified based on the Robson classification system. METHODS We retrospectively reviewed the clinical data of singleton cephalic nulliparous deliveries in labor at term between January 2018 and December 2021 and compared obstetrical outcomes between deliveries with and without neuraxial analgesia in women of Robson group 1 (spontaneous labor) and group 2a (induced labor). Statistical analyses were performed using the Wilcoxon ranked-sum test, Fisher's exact test, and logistic regression model. Statistical significance was set at p < 0.05. RESULTS We identified 2726 deliveries during the period, of which 387 deliveries (215 with analgesia and 172 without analgesia) were in Robson group 1 and 502 deliveries (258 with analgesia and 244 without analgesia) in Robson 2a. In Robson group 1 pregnancies, the cesarean section (CS) rate was higher in those who received analgesia (15%) than in those who did not (3%) (p = 0.0001). Multivariate analysis revealed that labor with analgesia was a significant risk factor for CS (p < 0.0001). Similarly, in Robson group 2a pregnancies, we observed a higher CS rate in those with analgesia than in those without analgesia (18 vs. 11%, p = 0.042). CONCLUSION A higher CS rate was observed in deliveries with analgesia than in those without analgesia both in the Robson group 1 and group 2a pregnancies.
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23
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Show KL, Maung TM, Phyo AP, Aung KT, Ngamjarus C, Aye NS, Tunçalp Ö, Betrán AP, Ku SK, Lumbiganon P, Tin KN, Mon NO, Bohren MA. Feasibility and readiness to implement Robson classification to monitor caesarean sections in public hospitals in Myanmar: Formative research. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001388. [PMID: 36963009 PMCID: PMC10022350 DOI: 10.1371/journal.pgph.0001388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/29/2022] [Indexed: 02/01/2023]
Abstract
Recent years have demonstrated an increase in caesarean section (CS) in most countries worldwide with considerable concern for the potential consequences. In 2015, WHO proposed the use of Robson classification as a global standard for assessing, monitoring and comparing CS rates. Currently, there is no standardized method to assess CS in Myanmar. The aim of this study was to explore health provider's perceptions about the feasibility, acceptability and readiness to implement the Robson classification in public hospitals across Myanmar. Ten maternities were purposively chosen, including all five teaching hospitals (tertiary referral hospital-level) affiliated to each medical university in Myanmar, which provide maternal and newborn care services, and district/township hospitals. Face-to-face in-depth interviews (IDI) with healthcare providers and facility administrators were conducted using semi-structured discussion guides. Facility and medical records systems were also assessed. We used the thematic analysis approach and Atlas.ti qualitative analysis software. A total of 67 IDIs were conducted. Most participants had willingness to implement Robson classification if there were sufficient human resources and training. Limited human resources, heavy workloads, and infrastructure resources were the major challenges described that may hinder implementation. The focal person for data entry, analysis, or reporting could be differed according to the level of facility, availability of human resources, and ability to understand medical terms and statistics. The respondents mentioned the important role of policy enforcement for the sustainability of data collection, interpretation and feedback. The optimal review interval period could therefore differ according to the availability of responsible persons, and the number of births. However, setting a fixed schedule according to the specific hospital for continuous monitoring of CS rate is required. In Myanmar, implementation of Robson classification is feasible while key barriers mainly related to human resource and training must be addressed to sustain.
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Affiliation(s)
- Kyaw Lwin Show
- Department of Medical Research, Ministry of Health, Yangon, Myanmar
- Department of Epidemiology and Biostatistics Department, Doctor of Epidemiology and Biostatistics Program, Khon Kaen University, Khon Kaen, Thailand
| | - Thae Maung Maung
- Department of Medical Research, Ministry of Health, Yangon, Myanmar
| | - Aung Pyae Phyo
- Department of Medical Research, Ministry of Health, Yangon, Myanmar
| | - Kyaw Thet Aung
- Department of Medical Research, Ministry of Health, Yangon, Myanmar
| | - Chetta Ngamjarus
- Faculty of Public Health, Department of Epidemiology and Biostatistics, Khon Kaen University, Khon Kaen, Thailand
| | | | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Ana Pilar Betrán
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Saw Kler Ku
- Department of Obstetrics and Gynaecology, University of Medicine 2, Yangon, Myanmar
| | - Pisake Lumbiganon
- Faculty of Medicine, Department of Obstetrics and Gynaecology, Khon Kaen University, Khon Kaen, Thailand
| | - Khaing Nwe Tin
- Department of Public Health, Maternal and Reproductive Health Division, Ministry of Health, Naypyitaw, Myanmar
| | - Nwe Oo Mon
- Nassau University Medical Center, New York, New York, United States of America
| | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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24
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Giaxi P, Lykeridoy A, Vivilaki VG. How can we attain enhanced quality assurance of the mode of birth? Eur J Midwifery 2022; 6:53. [PMID: 35974717 PMCID: PMC9348579 DOI: 10.18332/ejm/152157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/16/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Paraskevi Giaxi
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Aikaterini Lykeridoy
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Victoria G. Vivilaki
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
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25
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Shinejil U, Kiriya J, Shibanuma A, Miller R, Avirmed D, Jimba M. Association between Robson classification groups and cesarean delivery: a longitudinal analysis in Mongolia. AJOG GLOBAL REPORTS 2022; 2:100071. [DOI: 10.1016/j.xagr.2022.100071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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26
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Muraca GM, Joseph K, Razaz N, Ladfors LV, Lisonkova S, Stephansson O. Crude and adjusted comparisons of cesarean delivery rates using the Robson classification: A population-based cohort study in Canada and Sweden, 2004 to 2016. PLoS Med 2022; 19:e1004077. [PMID: 35913981 PMCID: PMC9377587 DOI: 10.1371/journal.pmed.1004077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/15/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Robson classification has become a global standard for comparing and monitoring cesarean delivery (CD) rates across populations and over time; however, this classification does not account for differences in important maternal, fetal, and obstetric practice factors known to impact CD rates. The objectives of our study were to identify subgroups of women contributing to differences in the CD rate in Sweden and British Columbia (BC), Canada using the Robson classification and to estimate the contribution of maternal, fetal/infant, and obstetric practice factors to differences in CD rates between countries and over time. METHODS AND FINDINGS We conducted a population-based cohort study of deliveries in Sweden (January 1, 2004 to December 31, 2016; n = 1,392,779) and BC (March 1, 2004 to April 31, 2017; n = 559,205). Deliveries were stratified into Robson categories and the CD rate, relative size of each group and its contribution to the overall CD rate were compared between the Swedish and the Canadian cohorts. Poisson and log-binomial regression were used to assess the contribution of maternal, fetal, and obstetric practice factors to spatiotemporal differences in Robson group-specific CD rates between Sweden and BC. Nulliparous women comprised 44.8% of the study population, while women of advanced maternal age (≥35 years) and women with overweight/obesity (≥25 kg/m2) constituted 23.5% and 32.4% of the study population, respectively. The CD rate in Sweden was stable at approximately 17.0% from 2004 to 2016 (p for trend = 0.10), while the CD rate increased in BC from 29.4% to 33.9% (p for trend < 0.001). Differences in CD rates between Sweden and BC varied by Robson group, for example, in Group 1 (nullipara with a term, single, cephalic fetus with spontaneous labor), the CD rate was 8.1% in Sweden and 20.4% in BC (rate ratio [RR] for BC versus Sweden = 2.52, 95% confidence interval [CI] 2.49 to 2.56, p < 0.001) and in Group 2 (nullipara, single, cephalic fetus, term gestation with induction of labor or prelabor CD), the rate of CD was 37.3% in Sweden and 45.9% in BC (RR = 1.23, 95% CI 1.22 to 1.25, p < 0.001). The effect of adjustment for maternal characteristics (e.g., age, body mass index), maternal comorbidity (e.g., preeclampsia), fetal characteristics (e.g., head position), and obstetric practice factors (e.g., epidural) ranged from no effect (e.g., among breech deliveries; Groups 6 and 7) to explaining up to 5.2% of the absolute difference in the CD rate (Group 2: adjusted CD rate in BC 40.7%, adjusted RR = 1.09, 95% CI 1.08 to 1.12, p < 0.001). Adjustment also explained a substantial fraction of the temporal change in CD rates among some Robson groups in BC. Limitations of the study include a lack of information on intrapartum details, such as labor duration as well as maternal and perinatal outcomes associated with the observed differences in CD rates. CONCLUSIONS In this study, we found that several factors not included in the Robson classification explain a significant proportion of the spatiotemporal difference in CD rates in some Robson groups. These findings suggest that incorporating these factors into explanatory models using the Robson classification may be useful for ensuring that public health initiatives regarding CD rates are evidence informed.
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Affiliation(s)
- Giulia M. Muraca
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, Eugeniahemmet, Stockholm, Sweden
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada
- Departments of Obstetrics and Gynecology and Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Ontario, Canada
- * E-mail:
| | - K.S. Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neda Razaz
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, Eugeniahemmet, Stockholm, Sweden
| | - Linnea V. Ladfors
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, Eugeniahemmet, Stockholm, Sweden
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia and the Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Olof Stephansson
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, Eugeniahemmet, Stockholm, Sweden
- Division of Women’s Health, Department of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
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Giaxi P, Gourounti K, Vivilaki VG, Lykeridoy K. Which classification system could empower the understanding of caesarean section rates in Greece? A review of systematic reviews. Eur J Midwifery 2022; 6:39. [PMID: 35801228 PMCID: PMC9201784 DOI: 10.18332/ejm/147993] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 03/12/2022] [Accepted: 04/03/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Worldwide there is an alarming increase in the caesarean delivery rate which has become a controversial topic. However, the reasons for this tendency are not clear. For example, in Greece alone, rates increased by almost 50% from 1983 to 1996. In order to better understand the causes of this phenomenon, we need to examine closely what groups of women undergo caesarean section (CS). To achieve this, it is essential to use a system that will enable us to monitor and compare caesarean delivery rates. Such a classification system should be easily adopted by obstetricians, midwives, and public health services. METHODS A review search of electronic databases concerning medical care was held from December 2020 to January 2021 in order to find systematic reviews which describe either theoretical or practical CS classification systems. RESULTS The most common classification systems fall into three main categories based on indication, urgency and maternal-based characteristics. According to users the highest rated classification system was women-based classifications in general. In particular the Robson Ten Group Classification System was considered to be the most valid to meet current local and international standards. The Robson classification system is praised for its robustness, simplicity, flexibility, and reproducibility. CONCLUSIONS The right implementation of the Robson Ten Group Classification System can facilitate an in-depth analysis of the main groups that increase CS rates and can be used to both review and monitor delivery practices both in Greece and abroad.
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Affiliation(s)
- Paraskevi Giaxi
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Kleanthi Gourounti
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Victoria G. Vivilaki
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Katerina Lykeridoy
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
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Colomar M, Colistro V, Sosa C, de Francisco LA, Betrán AP, Serruya S, De Mucio B. Cesarean section in Uruguay from 2008 to 2018: country analysis based on the Robson classification. An observational study. BMC Pregnancy Childbirth 2022; 22:471. [PMID: 35672663 PMCID: PMC9175367 DOI: 10.1186/s12884-022-04792-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of caesarean section has steadily increased, with Latin America being the region with the highest rates. Multiple factors account for that increase and the Robson classification is appropriate to compare determinants at the clinical level for caesarean section rates over time. The purpose of this study is to describe the evolution of caesarean section rates by Robson groups in Uruguay from 2008 to 2018 using a country level database. METHODS We included the records of all women giving birth in Uruguay (pregnancies ≥22 weeks and weights ≥500 g) with valid data in the mode of childbirth recorded in the Perinatal Information System database between 2008 and 2018. Caesarean section rates were calculated by Robson groups for each of the years included, disaggregated by care sector (public/private) and by geographical area (Capital City/Non-Capital), with time trends and their significance analyzed using linear regression models. RESULTS Of the total 485,263 births included in this research, the overall caesarean section rate was 43,1%. In 2018, among the groups at lower risk of caesarean section (1 to 4), the highest rates were seen in women in group 2B (98,8%), followed by those in group 4B (97,9%). A significant increase in the number of caesarean sections was seen in groups 2B (97,9 to 98,8%), 3 (8,36 to 11,1%) and 4 (A (22,7 to 26,9%) and B (95,4 to 97,9%) Significant growth was also observed in groups 5 (74,3 to 78,1%), 8 (90,6 to 95,5%), and 10 (39,1 to 46,7%). The private sector had higher rates of caesarean section for all groups throughout the period, except for women in group 9. The private sector in Montevideo presented the highest rates in the groups with the lowest risk of caesarean section (1, 2A, 3 and 4A), followed by the private sector outside of the capital. CONCLUSION Uruguay is no exception to the increasing caesarean section trend, even in groups of women who have lower risk of requiring caesarean section. The implementation of interventions aimed at reducing caesarean section in the groups with lower obstetric risk in Uruguay is warranted.
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Affiliation(s)
- Mercedes Colomar
- Montevideo Clinical and Epidemiological Research Unit, Montevideo, Uruguay.
- Latin American Center for Perinatology, Women and Reproductive Health (CLAP/WR), PAHO/WHO, Montevideo, Uruguay.
| | - Valentina Colistro
- Department of Quantitative Methods, School of Medicine, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - Claudio Sosa
- Department of Obstetrics and Gynecology, Pereira Rossell Hospital, School of Medicine, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - Luis Andres de Francisco
- Family, Health Promotion and Life Course, Pan American Health Organization, World Health Organization, Washington, United States
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Suzanne Serruya
- Latin American Center for Perinatology, Women and Reproductive Health (CLAP/WR), PAHO/WHO, Montevideo, Uruguay
| | - Bremen De Mucio
- Latin American Center for Perinatology, Women and Reproductive Health (CLAP/WR), PAHO/WHO, Montevideo, Uruguay
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Opiyo N, Torloni MR, Robson M, Ladfors L, Gholbzouri K, Kacerauskiene J, Vila-Candel R, Kessler J, Lucovnik M, Betrán AP. WHO's Robson platform for data-sharing on caesarean section rates. Bull World Health Organ 2022; 100:352-354. [PMID: 35521038 PMCID: PMC9047423 DOI: 10.2471/blt.21.287742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 01/13/2023] Open
Affiliation(s)
- Newton Opiyo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Maria Regina Torloni
- Evidence Based Healthcare Postgraduate Program, São Paulo Federal University, São Paulo, Brazil
| | | | - Lars Ladfors
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karima Gholbzouri
- Department of Health Promotion, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | | | | | - Joerg Kessler
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - Miha Lucovnik
- Department of Perinatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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Okonta PI, Fajola A, Umejiego C. An Analysis of Caesarean Sections in a Community Cottage Hospital in Nigeria's Niger Delta Using The Robson Classification. Niger Med J 2022; 63:91-97. [PMID: 38803701 PMCID: PMC11128161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Background The Robson ten group classification is recommended for classifying and comparing Caesarean Sections. This study aimed to review and classify all CS done at Obio Cottage hospital in 2018 using the Robson classification and to also identify areas of possible intervetions in reducing the CS rates. Methodology A retrospective review of all caesarean sections at Obio Cottage hospital from January to December 2018 using the Robson classification. Results The CS rate was 32.4%. Three groups - Groups 1 (27.% ), 2 (11.2%) and 5 (30.1%) contributed 68.5% to the overall CS rate. Group 8 had the least contribution to CS with 3.4%. Women in Robson group 3 had the lowest group CS rate of 6.86%, while the group CS rate for group 1, and 5.1 were 26.34% and 70.49% respectively. Conclusion The CS rate of 32.4% is comparatively high. This analysis of the CS using the Robson classification system has revealed areas for further scrutiny and intervention. There is need to review the package of care provided to women in labour and increase the number of women offered a trial of labour after a Caesarean birth.
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Affiliation(s)
- Patrick I. Okonta
- Sabbaticcal Research Advisor, SPDC, Port Harcourt, Rivers State
- Department of Obstetrics and Gynaecology, Delta State University, Abraka, Delta State
| | | | - Chidozie Umejiego
- Medical Director, Obio Cottage Hospital, Port Harcourt, Rivers State
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Jamshed S, Chien SC, Tanweer A, Asdary RN, Hardhantyo M, Greenfield D, Chien CH, Weng SF, Jian WS, Iqbal U. Correlation Between Previous Caesarean Section and Adverse Maternal Outcomes Accordingly With Robson Classification: Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 8:740000. [PMID: 35096855 PMCID: PMC8795992 DOI: 10.3389/fmed.2021.740000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/29/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The increasing rates of Caesarean section (CS) beyond the WHO standards (10–15%) pose a significant global health concern. Objective: Systematic review and meta-analysis to identify an association between CS history and maternal adverse outcomes for the subsequent pregnancy and delivery among women classified in Robson classification (RC). Search Strategy: PubMed/Medline, EbscoHost, ProQuest, Embase, Web of Science, BIOSIS, MEDLINE, and Russian Science Citation Index databases were searched from 2008 to 2018. Selection Criteria: Based on Robson classification, studies reporting one or more of the 14 adverse maternal outcomes were considered eligible for this review. Data Collection: Study design data, interventions used, CS history, and adverse maternal outcomes were extracted. Main Results: From 4,084 studies, 28 (n = 1,524,695 women) met the inclusion criteria. RC group 5 showed the highest proportion among deliveries followed by RC10, RC7, and RC8 (67.71, 32.27, 0.02, and 0.001%). Among adverse maternal outcomes, hysterectomy had the highest association after preterm delivery OR = 3.39 (95% CI 1.56–7.36), followed by Severe Maternal Outcomes OR = 2.95 (95% CI 1.00–8.67). We identified over one and a half million pregnant women, of whom the majority were found to belong to RC group 5. Conclusions: Previous CS was observed to be associated with adverse maternal outcomes for the subsequent pregnancies. CS rates need to be monitored given the prospective risks which may occur for maternal and child health in subsequent births.
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Affiliation(s)
- Shazia Jamshed
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Sultan Zainal Abidin (UniSZA), Kuala Terengganu, Malaysia.,Qualitative Research-Methodological Application in Health Sciences Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia
| | - Shuo-Chen Chien
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
| | - Afifa Tanweer
- Department of Nutrition Sciences, School of Health Sciences, University of Management and Technology, Lahore, Pakistan
| | - Rahma-Novita Asdary
- Masters Program in Department of Global Health & Development, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Muhammad Hardhantyo
- Graduate Program of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Faculty of Health Science, Universitas Respati Yogyakarta, Depok, Indonesia.,Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Depok, Indonesia
| | - David Greenfield
- The Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales (UNSW) Medicine, Sydney, NSW, Australia.,Linéaire Projects, Sydney, NSW, Australia
| | - Chia-Hui Chien
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Office of Public Affairs, Taipei Medical University, Taipei, Taiwan
| | - Shuen-Fu Weng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Shan Jian
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,School of Health Care Administration, School of Gerontology Health Management, Graduate Institute of Data Science, Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Usman Iqbal
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Masters Program in Department of Global Health & Development, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Ph.D. Program in Depatment of Global Health & Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
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32
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Haque M, Umar B. Growing concern over rising caesarean section rates: Is it a problem for low- and middle-income countries only? ADVANCES IN HUMAN BIOLOGY 2022. [DOI: 10.4103/aihb.aihb_148_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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33
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Rookesh Z, Kaviani M, Zarshenas M, Akbarzadeh M. Comparison of Maternal-Infant Attachment in Cesarean Delivery Based on Robson Classification: A Cross-Sectional Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:500-507. [PMID: 34900648 PMCID: PMC8607887 DOI: 10.4103/ijnmr.ijnmr_230_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/07/2019] [Accepted: 07/17/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Robson criteria allows for standardized comparisons of data and possible driving changes in Cesarean Section (C/S) rates and complications. The aimed to compare maternal-infant attachment in C/S based on Robson Classification. MATERIALS AND METHODS This cross-sectional prospective study was conducted on 369 women who had undergone C/S in Hazrate Zeinab Peace Be Upon Him (PBUH), Hafez, and Shooshtari hospitals affiliated to Shiraz University of Medical Sciences, Iran from April 2018 to March 2019. The study data were collected using a demographic form, an obstetric form, and Avant Checklist (AC) at postpartum and pre-discharge stages. Each participant was placed in Robson classification and the attachment score was calculated in each Robson Classification, and a comparison was made among the 10 groups. The data were analyzed into the SPSS 16 software and using descriptive statistics and paired t test. RESULTS The total mean (SD) score of attachment was 38.73 (18.65) at 1-7 h postpartum and 90.52 (23.79) at pre-discharge. The highest total mean (SD) score of attachment was observed in group 6 (86.78 (8.70) at postpartum and 118.67 (4.47) at pre-discharge). The lowest total mean (SD) score of attachment was observed in group 10 (12.79 (2.37) at 1-7 h postpartum and 45.44 (7.99) at pre-discharge). CONCLUSIONS Obstetric characteristics in Robson Classification, parity, previous C/S, gestational age, onset of labor, fetal presentation, and number of fetuses were effective in clarifying information. The use of this system is necessary to determine the causes of increased C/S cases in low-income and middle-income countries.
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Affiliation(s)
- Zohreh Rookesh
- Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maasumeh Kaviani
- Department of Midwifery, Community Based Psychiatric Care Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahnaz Zarshenas
- Community Based Psychiatric Care Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Akbarzadeh
- Department of Midwifery, Maternal – Fetal Medicine Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran,Address for correspondence: Mrs. Marzieh Akbarzadeh, Maternal – Fetal Medicine Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran. E-mail:
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Matei A, Dimitriu MC, Roșu GA, Furău CG, Ionescu CA. Investigating Caesarean Section Practice among Teenage Romanian Mothers Using Modified Robson Ten Group Classification System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10727. [PMID: 34682473 PMCID: PMC8536039 DOI: 10.3390/ijerph182010727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022]
Abstract
The Robson ten-group classification system is a recognized effective method of assessing caesarean rate. It is based on dividing patients into ten mutually exclusive groups, focusing on six maternal and newborn variables (parity, gestational age, plurality, foetal presentation, previous caesarean, and mode of labour onset). The aim of our analysis was twofold: first, to present the implementation of Robson classification in a pregnant teenage population; and second, to identify the indications for CS in the adolescent population. This study was designed as a one-year prospective analysis and considered all women younger than 20 years of age who delivered in a tertiary care hospital. Before discharge, women who had caesarean delivery responded to a questionnaire regarding their education, prenatal surveillance, and obstetrical history. Caesarean sections accounted for 47.01% of all births. A proportion of 24.57% of the participants had at least one previous caesarean section. Group 10 (all women with a single cephalic preterm pregnancy) was second most often identified among women in middle adolescence (14.03%); 32.20% of the participants in late adolescence were in group 5 (multiparas with a scarred uterus, single cephalic term pregnancy). Differences between the two age groups were not statistically different (p = 0.96). Abnormal cardiotocographic findings (38.23%), the arrest of descent (19.11%) and arrest of dilation (19.11%), were the most frequent indications for caesareans in Robson group 1. Neonates from mothers in Robson groups 8 (women with a multiple pregnancy) and 7 (multiparas single breech pregnancy) had the most unfavourable outcomes regarding gestational age at delivery and admission to the intensive care unit. We concluded that future focus on obstetrical management is mandatory in Robson groups 7 and 8. Adolescents in Robson group 1 (nulliparas, single cephalic term pregnancy, spontaneous labour) are the primary beneficiaries of strategies to reduce caesarean sections rates.
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Affiliation(s)
- Alexandra Matei
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy Doctoral School, 020021 Bucharest, Romania;
| | - Mihai Cornel Dimitriu
- Department of Obstetrics and Gynecology, “Sf. Pantelimon” Emergency Clinical Hospital, 021659 Bucharest, Romania; (M.C.D.); (G.A.R.)
| | - George Alexandru Roșu
- Department of Obstetrics and Gynecology, “Sf. Pantelimon” Emergency Clinical Hospital, 021659 Bucharest, Romania; (M.C.D.); (G.A.R.)
| | - Cristian George Furău
- Department of Obstetrics and Gynecology, Faculty of Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, Romania;
| | - Crîngu Antoniu Ionescu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy Doctoral School, 020021 Bucharest, Romania;
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Pulvermacher C, Van de Vondel P, Gerzen L, Gembruch U, Welchowski T, Schmid M, Merz WM. Analysis of cesarean section rates in two German hospitals applying the 10-Group Classification System. J Perinat Med 2021; 49:818-829. [PMID: 33827151 DOI: 10.1515/jpm-2020-0505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/18/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In Germany, cesarean section (CS) rates more than doubled within the past two decades. For analysis, auditing and inter-hospital comparison, the 10-Group Classification System (TGCS) is recommended. We used the TGCS to analyze CS rates in two German hospitals of different levels of care. METHODS From October 2017 to September 2018, data were prospectively collected. Unit A is a level three university hospital, unit B a level one district hospital. The German birth registry was used for comparison with national data. We performed two-sample Z tests and bootstrapping to compare aggregated (unit A + B) with national data and unit A with unit B. RESULTS In both datasets (national data and aggregated data unit A + B), Robson group (RG) 5 was the largest contributor to the overall CS rate. Compared to national data, group sizes in RG 1 and 3 were significantly smaller in the units under investigation, RG 8 and 10 significantly larger. Total CS rates between the two units differed (40.7 vs. 28.4%, p<0.001). The CS rate in RG 5 and RG 10 was different (p<0.01 for both). The most relative frequent RG in both units consisted of group 5, followed by group 10 and 2a. CONCLUSIONS The analysis allowed us to explain different CS rates with differences in the study population and with differences in the clinical practice. These results serve as a starting point for audits, inter-hospital comparisons and for interventions aiming to reduce CS rates.
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Affiliation(s)
| | | | - Lydia Gerzen
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Thomas Welchowski
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Waltraut M Merz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
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D'Agostini Marin DF, da Rosa Wernke A, Dannehl D, de Araujo D, Koch GF, Marçal Zanoni K, Baschirotto Dorigon Coral K, Valeriano Guimarães N, Feuerschuette O, Pinto Moehlecke Iser B. The Project Appropriate Birth and a reduction in caesarean section rates: an analysis using the Robson classification system. BJOG 2021; 129:72-80. [PMID: 34529333 DOI: 10.1111/1471-0528.16919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was to assess caesarean section (CS) rates before and after the implementation of the Project Appropriate Birth (PPA), based on the Robson ten group classification system. DESIGN A before-and-after study. SETTING Maternity hospital in South Brazil. POPULATION All pregnant women attending from April 2016 to April 2017 (period 1, pre-implementation of PPA) and from June 2017 to June 2018 (period 2, post-implementation of PPA). METHODS Maternal and obstetric characteristics were evaluated, including Robson's classification, based on the characteristics of pregnancy and childbirth. A chi-square test and crude and adjusted relative rates were used to analyse the study variables. The significance level was set at 5%. MAIN OUTCOME MEASURES The CS rate for each group, their contribution to the overall CS rate and the differences in these contributions before and after PPA implementation. RESULTS The CS rates decreased from 62.4 to 55.6%, which represented a 10.9% reduction after the implementation of the PPA. Pregnant women in Robson classification groups 1-4 had a 21.4% reduction in CS rates, ranging from 49.1 to 38.6%. The greatest contributors to the overall CS rates were group 5 and group 2, accounting for more than 60% of the CS deliveries. CONCLUSION The study results suggest that Project Appropriate Birth had an impact on the reduction of CS rates, especially in Robson classification groups 1 through 4, which indicates that providing mothers with evidence-based interventions for labour and childbirth assistance contributed to reduce CS rates. TWEETABLE ABSTRACT The Project Appropriate Birth is an innovative project that has demonstrated promising results, suggesting that interventions based on scientific evidence can lead to real changes in childbirth care, contributing to reduce CS rates. The aim of the PPA is to promote activities to improve childbirth care and encourage vaginal delivery. In this study, 6238 pregnant women admitted to the hospital for delivery were included and classified into one of the Robson 10-group classification. Findings revealed a 10.9% reduction in the overall CS rate and a 21.4% reduction for pregnant women in Robson classification groups 1 through 4, after the implementation of the PPA.
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Affiliation(s)
- D F D'Agostini Marin
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - A da Rosa Wernke
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - D Dannehl
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - D de Araujo
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - G F Koch
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - K Marçal Zanoni
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - K Baschirotto Dorigon Coral
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - N Valeriano Guimarães
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - O Feuerschuette
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
| | - B Pinto Moehlecke Iser
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina at Tubarão, Santa Catarina, Brazil
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Paixao ES, Bottomley C, Smeeth L, da Costa MCN, Teixeira MG, Ichihara MY, Gabrielli L, Barreto ML, Campbell OMR. Using the Robson classification to assess caesarean section rates in Brazil: an observational study of more than 24 million births from 2011 to 2017. BMC Pregnancy Childbirth 2021; 21:589. [PMID: 34461851 PMCID: PMC8406968 DOI: 10.1186/s12884-021-04060-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Applying the Robson classification to all births in Brazil, the objectives of our study were to estimate the rates of caesarean section delivery, assess the extent to which caesarean sections were clinically indicated, and identify variation across socioeconomic groups. METHODS We conducted a population-based study using routine records of the Live Births Information System in Brazil from January 1, 2011, to December 31, 2017. We calculated the relative size of each Robson group; the caesarean section rate; and the contribution to the overall caesarean section rate. We categorised Brazilian municipalities using the Human Development Index to explore caesarean section rates further. We estimated the time trend in caesarean section rates. RESULTS The rate of caesarean sections was higher in older and more educated women. Prelabour caesarean sections accounted for more than 54 % of all caesarean deliveries. Women with a previous caesarean section (Group 5) made up the largest group (21.7 %). Groups 6-9, for whom caesarean sections would be indicated in most cases, all had caesarean section rates above 82 %, as did Group 5. The caesarean section rates were higher in municipalities with a higher HDI. The general Brazilian caesarean section rate remained stable during the study period. CONCLUSIONS Brazil is a country with one of the world's highest caesarean section rates. This nationwide population-based study provides the evidence needed to inform efforts to improve the provision of clinically indicated caesarean sections. Our results showed that caesarean section rates were lower among lower socioeconomic groups even when clinically indicated, suggesting sub-optimal access to surgical care.
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Affiliation(s)
- Enny S Paixao
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil.
| | - Christian Bottomley
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Conceicao N da Costa
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia - Salvador (BA), Salvador, Brazil
| | - Maria Gloria Teixeira
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia - Salvador (BA), Salvador, Brazil
| | - Maria Yury Ichihara
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
| | - Ligia Gabrielli
- Institute of Collective Health, Federal University of Bahia - Salvador (BA), Salvador, Brazil
| | - Mauricio L Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde, Fiocruz, Salvador, Bahia, Brazil
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Geze S, Tura AK, Fage SG, van den Akker T. Can the Robson 10 Group Classification System help identify which groups of women are driving the high caesarean section rate in major private hospitals in eastern Ethiopia? A cross-sectional study. BMJ Open 2021; 11:e047206. [PMID: 34446486 PMCID: PMC8395281 DOI: 10.1136/bmjopen-2020-047206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The rates of caesarean section (CS) in Ethiopian private hospitals are high compared with those in public facilities, and there are limited descriptions of groups of women contributing to these high rates. The objective of this study was to describe the groups contributing to increased CS rates using the Robson classification in two major private hospitals in eastern Ethiopia. DESIGN Cross-sectional study. SETTING Two major private hospitals in eastern Ethiopia. PARTICIPANTS All women who gave birth from 9 January 2019 to 8 January 2020 in two major private hospitals in eastern Ethiopia. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the Robson 10 Group Classification System. The secondary outcome was indication for CS as recorded in the medical files. RESULTS Of 1203 births in both hospitals combined during the study period, 415 (34.5%) were by CS. Women with a uterine scar due to previous CS (group 5), single cephalic term multiparous women in spontaneous labour (group 3) and single cephalic term nulliparous women in spontaneous labour (group 1) were the leading groups contributing 33%, 27.5% and 17.1%, respectively. The leading documented indications were fetal compromise (29.4%), previous CS (27.2%) and obstructed labour (12.3%). CONCLUSION More than three-fourths of CS were performed among Robson groups 5, 3 and 1, indicating inadequate trial of labour after CS or management of labour among relatively low-risk groups (3 and 1). Improving management of spontaneous labour and strengthening clinical practice around safely providing the option of vaginal birth after CS practice are strategies required to reduce the high CS rates in these private facilities.
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Affiliation(s)
- Shegaw Geze
- Department of Midwifery, College of Health and Medical Sciences, Wolkite University, Wolkite, Ethiopia
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sagni Girma Fage
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Thomas van den Akker
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of obstetrics and gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
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Altayeva AA, Issenova SS, Machtejeviene E, Bodykov GZ, Bishekova BN. Results of Using the Robson Classification in Kazakhstan. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Over the past few decades, the cesarean section frequency has increased significantly in many countries around the world, especially in the countries with high and medium income. The World Health Organization recommends 10–15% as the optimum cesarean section frequency. In Kazakhstan, the frequency of operative delivery in 2018 was 23.5%.
AIM: The article is aimed at analyzing the caesarean section frequency following the Robson classification in Kazakhstan at Level II and III obstetric institutions, identifying the groups that make the greatest contribution to the overall cesarean section frequency, studying the clinical reasons in these groups, and identifying the ways to reduce unneeded cesarean sections.
METHODS: A prospective study was performed at the Level II and III obstetric facilities in Almaty. On admission for delivery, all women were assigned following the Robson classification. The indices of cesarean section in each of 10 groups and the absolute and relative contribution to the overall cesarean section frequency were calculated. The patient data were prospectively entered into a computer application and processed in MS Excel and Statistica version 23. The results were presented using the Robson classification. The odds ratios were calculated with a confidence interval of 95%.
RESULTS: For the period from January 1, 2019, to December 31, 2019, 12,395 women parturiated at Level II and III obstetric facilities. The main contributors to the overall cesarean section frequency at Level II and III obstetric facilities were Group 5 (multiparous women with uterine scars) – 46.3% (Level II facility) and 37.5% (Level III facility), Group 2 (12.4%) and (12.4%), Group 1 (12%) and (9.6%), and Group 10 (11.4%) at the Level III facility.
CONCLUSION: The Robson classification has been used for the 1st time in Kazakhstan which has made it possible to identify the reasons that make the greatest contribution to the overall cesarean section frequency. The use of monitoring for analyzing the cesarean section frequency will make it possible to compare the Kazakhstan data with the foreign data and determine the organizational measures aimed at reducing the frequency of operative delivery. The strategies to reduce unneeded cesarean section should focus on reducing the cesarean section frequency in nulliparous women. In the absence of contraindications, natural delivery should be advised to the women with uterine scars.
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Association of body mass index and maternal age with first stage duration of labour. Sci Rep 2021; 11:13843. [PMID: 34226624 PMCID: PMC8257589 DOI: 10.1038/s41598-021-93217-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/15/2021] [Indexed: 12/31/2022] Open
Abstract
To evaluate associations between early-pregnancy body mass index (BMI) and active first stage labour duration, accounting for possible interaction with maternal age, we conducted a cohort study of women with spontaneous onset of labour allocated to Robson group 1. Quantile regression analysis was performed to estimate first stage labour duration between BMI categories in two maternal age subgroups (more and less than 30 years). Results show that obesity (BMI > 30) among younger women (< 30 years) increased the median labour duration of first stage by 30 min compared with normal weight women (BMI < 25), and time difference estimated at the 90th quantile was more than 1 h. Active first stage labour time differences between obese and normal weight women was modified by maternal age. In conclusion: (a) obesity is associated with longer duration of first stage of labour, and (b) maternal age is an effect modifier for this association. This novel finding of an effect modification between BMI and maternal age contributes to the body of evidence that supports a more individualized approach when describing labour duration.
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Cesarean Section Rate and Perinatal Outcome Analyses According to Robson's 10-Group Classification System. Matern Child Health J 2021; 25:1474-1481. [PMID: 34181155 DOI: 10.1007/s10995-021-03183-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The cesarean delivery (CD) rate is increasing worldwide. An internationally recognized classification system had been required to analyse the trend and its possible consequences in a standardized manner. The goal of this study was to identify the main contributors to the CD rate at the Medical University of Vienna in an 11-year time period (2003-2013) and to analyse neonatal outcome parameters within the ten Robson categories. METHODS This is a retrospective data-analysis of singleton and twin pregnancies in cephalic, breech and transverse presentation with a gestational age between 23 and 42 weeks. The cases were divided into ten classes based on the Robson criteria. CD rates and perinatal outcome parameters were analysed within each Robson class. The outcome parameters included: NICU-admission rate and 5 min Apgar score values < 7. RESULTS The overall CD rate was at 44.2%. Within Robson class 5 the CD rate was the highest at 99.1%. Main contributors were Robson class 5 at 20.6%, followed by class 2 at 17.1% and class 8 at 15.0%. Neonatal outcome analyses revealed significant differences between the Robson classes. CONCLUSIONS The main contributors to the CD rate were determined. We suggest reconsidering the frequently applied birth mode especially for Robson class 2, 4, 5 and 8. Lowering the CD rate could be achievable, if a careful delivery management and an individual risk evaluation is provided. It is important to reduce the CD rate in the individual Robson classes under consideration of perinatal outcome parameters, since a reduction should only take place where it is clinically useful and relevant.
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Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health 2021; 6:bmjgh-2021-005671. [PMID: 34130991 PMCID: PMC8208001 DOI: 10.1136/bmjgh-2021-005671] [Citation(s) in RCA: 446] [Impact Index Per Article: 148.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background The caesarean section (CS) rate continues to increase across high-income, middle-income and low-income countries. We present current global and regional CS rates, trends since 1990 and projections for 2030. Methods We obtained nationally representative data on the CS rate from countries worldwide from 1990 to 2018. We used routine health information systems reports and population-based household surveys. Using the latest available data, we calculated current regional and subregional weighted averages. We estimated trends by a piecewise analysis of CS rates at the national, regional and global levels from 1990 to 2018. We projected the CS rate and the number of CS expected in 2030 using autoregressive integrated moving-average models. Results Latest available data (2010–2018) from 154 countries covering 94.5% of world live births shows that 21.1% of women gave birth by caesarean worldwide, averages ranging from 5% in sub-Saharan Africa to 42.8% in Latin America and the Caribbean. CS has risen in all regions since 1990. Subregions with the greatest increases were Eastern Asia, Western Asia and Northern Africa (44.9, 34.7 and 31.5 percentage point increase, respectively) while sub-Saharan Africa and Northern America (3.6 and 9.5 percentage point increase, respectively) had the lowest rise. Projections showed that by 2030, 28.5% of women worldwide will give birth by CS (38 million caesareans of which 33.5 million in LMIC annually) ranging from 7.1% in sub-Saharan Africa to 63.4% in Eastern Asia. Conclusion The use of CS has steadily increased worldwide and will continue increasing over the current decade where both unmet need and overuse are expected to coexist. In the absence of global effective interventions to revert the trend, Southern Asia and sub-Saharan Africa will face a complex scenario with morbidity and mortality associated with the unmet need, the unsafe provision of CS and with the concomitant overuse of the surgical procedure which drains resources and adds avoidable morbidity and mortality. If the Sustainable Development Goals are to be achieved, comprehensively addressing the CS issue is a global priority.
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Affiliation(s)
- Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Jiangfeng Ye
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ann-Beth Moller
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - João Paulo Souza
- Department of Social Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zahroh RI, Disney G, Betrán AP, Bohren MA. Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017. BMJ Glob Health 2021; 5:bmjgh-2020-003844. [PMID: 33380412 PMCID: PMC7780721 DOI: 10.1136/bmjgh-2020-003844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Caesarean section (CS) rates are increasing globally. CS can be a live-saving procedure when medically indicated, but it comes with higher risks for women and newborns when done without medical indication. Crucially, inequalities in who receives CS exist, both within and across countries. Understanding factors driving increasing rates and inequalities of CS is imperative to optimise the use of this life-saving intervention. This study aimed to investigate trends of CS use and inequalities across sociodemographic characteristics in Indonesia over a 30-year period. METHODS Seven waves of the Indonesia Demographic and Health Survey were used to estimate trends and inequalities in CS from 1987 to 2017. Relative and absolute inequalities across a range of sociodemographic characteristics were estimated and trends in inequalities were assessed through changes in rate ratio and rate difference. RESULTS The proportion of facility-based births in Indonesia has increased in the past 30 years, coinciding with an increase in CS rate (CSR) (1991 CSR: 1.6% (95% CI 1.3 to 1.9); 2017 CSR: 17.6% (95% CI 16.7 to 18.5)). Higher rates of CS are observed mostly in Western Indonesia, while lower CSRs are observed in Eastern Indonesia. Inequalities of CSRs in Indonesia are observed across type of health facility (public/private), regions, places of residence, wealth quintiles and maternal education, with the highest CSRs in more affluent and educated groups. Widening absolute inequalities of CS are observed across all sociodemographic characteristics, except facility type, where CSR gaps between public and private facilities have closed on both relative and absolute scales. CONCLUSION This study provides evidence of increasing trends in CSRs and widening absolute inequalities in CSRs across different sociodemographic groups of women in Indonesia. The context of increasing CSRs across society, however, may have resulted in more stable relative inequalities. Improving understanding of the drivers of these trends in Indonesia and, particularly, of women's and providers' perspectives and preferences for childbirth, should be prioritised to optimise the use of CS.
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Affiliation(s)
- Rana Islamiah Zahroh
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - George Disney
- Disability and Health Unit, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Buyuk GN, Kansu-Celik H, Kaplan ZAO, Kisa B, Ozel S, Engin-Ustun Y. Risk Factors for Intrapartum Cesarean Section Delivery in Low-risk Multiparous Women Following at Least a Prior Vaginal Birth (Robson Classification 3 and 4). REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:436-441. [PMID: 34318468 PMCID: PMC10411140 DOI: 10.1055/s-0041-1731378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/19/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate the risk factors for cesarean section (C-section) in low-risk multiparous women with a history of vaginal birth. METHODS The present retrospective study included low-risk multiparous women with a history of vaginal birth who gave birth at between 37 and 42 gestational weeks. The subjects were divided into 2 groups according to the mode of delivery, as C-section Group and vaginal delivery Group. Risk factors for C-section such as demographic characteristics, ultrasonographic measurements, smoking, weight gain during pregnancy (WGDP), interval time between prior birth, history of macrosomic birth, and cervical dilatation at the admission to the hospital were obtained from the charts of the patients. Obstetric and neonatal outcomes were compared between groups. RESULTS The most common C-section indications were fetal distress and macrosomia (33.9% [n = 77 and 20.7% [n = 47] respectively). A bivariate correlation analysis demonstrated that mothers aged > 30 years old (odds ratio [OR]: 2.09; 95% confidence interval [CI]: 1.30-3.34; p = 0.002), parity >1 (OR: 1.81; 95%CI: 1.18-2.71; p = 0.006), fetal abdominal circumference (FAC) measurement > 360 mm (OR: 34.20; 95%CI: 8.04-145.56; p < 0.001)) and < 345 mm (OR: 3.06; 95%CI: 1.88-5; p < 0.001), presence of large for gestational age (LGA) fetus (OR: 5.09; 95%CI: 1.35-19.21; p = 0.016), premature rupture of membranes (PROM) (OR: 1.52; 95%CI: 1-2.33; p = 0.041), and cervical dilatation < 5cm at admission (OR: 2.12; 95%CI: 1.34-3.34; p = 0.001) were associated with the group requiring a C-section. CONCLUSION This is the first study evaluating the risk factors for C-section in low-risk multiparous women with a history of vaginal birth according to the Robson classification 3 and 4. Fetal distress and suspected fetal macrosomia constituted most of the C-section indications.
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Affiliation(s)
- Gul Nihal Buyuk
- Department of Obstetrics and Gynecology, University of Health Sciences, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Hatice Kansu-Celik
- Department of Obstetrics and Gynecology, University of Health Sciences, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Zeynep Asli Oskovi Kaplan
- Department of Obstetrics and Gynecology, University of Health Sciences, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Burcu Kisa
- Department of Obstetrics and Gynecology, University of Health Sciences, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Sule Ozel
- Department of Obstetrics and Gynecology, University of Health Sciences, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
| | - Yaprak Engin-Ustun
- Department of Obstetrics and Gynecology, University of Health Sciences, Zekai Tahir Burak Woman's Health, Education and Research Hospital, Ankara, Turkey
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Artuso H, Davis DL. Trends and characteristics of women undergoing induction of labour in a tertiary hospital setting: A cross-sectional study. Women Birth 2021; 35:e181-e187. [PMID: 34034992 DOI: 10.1016/j.wombi.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In many well-resourced countries, rising rates of intervention are being observed during pregnancy, labour and childbirth with induction of labour (IOL) fast becoming one of the most common. In Australia, the rate of induction of labour has increased by over 30% since 2007, and today one in three women have their labours induced. We do not however have a good understanding of the contribution of specific obstetric populations to this trend. METHODS We examine the contribution of specific obstetric populations to induction of labour over a six-year period at one tertiary maternity service, using the Nippita classification system. Average Annual Percentage Changes (AAPC) were calculated along with 95% confidence intervals and P values set at 0.05. RESULTS The overall rate of induction of labour increased from 21.3% in 2012 to 30.9% in 2017, representing an Average Annual Percent Change of 8.1, P<0.0001 (95% CI 7-9.6). The greatest AAPC was seen in group 5 (parous, no previous caesarean section, 39-40 weeks, single cephalic), followed by group 2 (nulliparous, 39-40 weeks, single cephalic) and 1 (nulliparous, 37-38 weeks, single cephalic). CONCLUSIONS The use of the Nippita classification system allowed for standardised comparison across timepoints, facilitating identification of the subpopulations driving changes in rates of induction of labour. Rates of induction of labour saw a year on year increase which in this maternity service, it is not being driven by post-dates pregnancies. Further work is required to understand the role of other potential contributors such as diabetes.
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Affiliation(s)
- Heather Artuso
- Centenary Hospital for Women and Children, ACT and University of Canberra, Kirinari St., Bruce, ACT 2617, Australia
| | - Deborah L Davis
- ACT Government Health Directorate and University of Canberra, Kirinari St., Bruce, ACT 2617, Australia.
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Acharya K, Paudel YR. Trend and Sociodemographic Correlates of Cesarean Section Utilization in Nepal: Evidence from Demographic and Health Surveys 2006-2016. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8888267. [PMID: 33997044 PMCID: PMC8112916 DOI: 10.1155/2021/8888267] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 03/08/2021] [Accepted: 03/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Addressing inequalities in accessing emergency obstetric care is crucial for reducing the maternal mortality ratio. This study was undertaken to examine the time trends and sociodemographic correlates of cesarean section (CS) utilization in Nepal between 2006 and 2016. Methods. Data from the Nepal Demographic and Health Surveys (NDHS) 2006, 2011, and 2016 were sourced for this study. Women who had a live birth in the last five years of the survey were the unit of analysis for this study. Absolute and relative inequalities in CS utilization were expressed in terms of rate difference and rate ratios, respectively. We used multivariable regression models to assess the CS rate by background sociodemographic characteristics of women. RESULTS Age and parity-adjusted CS rates were found to have increased almost threefold (from 3.2%, 95% CI: 2.1-4.3 in 2006 to 10.5%; 95% CI: 8.9-11.9 in 2016) over the decade. In 2016, women from mountain region (3.0%), those from the lowest wealth quintile (2.4%), and those living in Karnali province (2.4%) had CS rate below 5%. Whereas women from the highest wealth quintile (25.1%), with higher education (21.2%), and those delivering in private facilities (37.1%) had CS rate above 15%. Women from the highest wealth quintile (OR-3.3; 95% CI: 1.6-7.0) compared to women from the lowest wealth quintile and those delivered in private/NGO-run facilities (OR-3.6; 95% CI: 2.7-4.9) compared to women delivering in public facilities were more than three times more likely to deliver by CS. CONCLUSION To improve maternal and newborn health, strategies need to be revised to address the underuse of CS among poor, those living in mountain region and Province 2, Lumbini province, Karnali province, and Sudhurpaschim province. Simultaneously, there is a pressing need for policies, guidelines, and continuous monitoring of CS rates to reduce overuse among rich women, women with higher education, and those giving childbirth in private facilities.
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Affiliation(s)
| | - Yuba Raj Paudel
- School of Public Health, University of Alberta, Edmonton, Canada
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Mayne L, Liu C, Tanaka K, Amoako A. Caesarean section rates: applying the modified ten-group Robson classification in an Australian tertiary hospital. J OBSTET GYNAECOL 2021; 42:61-66. [PMID: 33938362 DOI: 10.1080/01443615.2021.1873923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was to determine the main contributors to caesarean section (CS) rates at an Australian tertiary hospital. We conducted a retrospective review of women who delivered in an Australian tertiary hospital between 2014 and 2017. Women were allocated according to a modified Robson Ten-Group Classification System and CS indications were collected in nulliparous women and women with previous CS. The largest contributor to the 35.7% overall CS rate was women with a term cephalic infant and a previous CS (31.5% relative CS rate) and the most common indication was repeat CS. The group CS rate in nulliparous women with a cephalic term infant was higher when labour was induced compared to occurring spontaneously (36.6% and 18.1% respectively). The primary CS indication for these women was labour dystocia and maternal request was the most common CS indication for nulliparous women with a pre-labour CS.IMPACT STATEMENTWhat is already known on this subject? Significantly increasing caesarean section (CS) rates continue to prompt concern due to the associated neonatal and maternal risks. The World Health Organisation have endorsed the Robson Ten-Group Classification System to identify and analyse CS rate contributors.What do the results of this study add? We have used the modified Robson Ten-Group Classification System to identify that women with cephalic term infants who are nulliparous or who have had a previous CS are the largest contributors to overall CS rates. CS rates were higher in these nulliparous women if labour was induced compared to occurring spontaneously and the primary CS indication was labour dystocia. In nulliparous women with a CS prior to labour the most common CS indication was maternal request. Majority of women with a previous CS elected for a repeat CS.What are the implications of these findings for clinical practice? Future efforts should focus on minimising repeat CS in multiparous women and primary CS in nulliparous women. This may be achieved by redefining the definition of labour dystocia, exploring maternal request CS reasoning and critically evaluating induction timing and indication. Appropriately promoting a trial of labour in women with a previous CS in suitable candidates may reduce repeat CS incidence.
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Affiliation(s)
- Leah Mayne
- Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, Griffith University, Gold Coast, Australia
| | - Cathy Liu
- Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Keisuke Tanaka
- Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Akwasi Amoako
- Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
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Dong W, Xie S. Construction of a prediction model and a prevention control system for cesarean section rate based on the Robson classification system. Am J Transl Res 2021; 13:3238-3245. [PMID: 34017494 PMCID: PMC8129404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To systematically explore the risk factors that influence cesarean section rate, and establish a prediction model to investigate a system effectively reducing cesarean section rates. METHODS This retrospective study was carried out in the medical institutions in Xingtai city, where cesarean section could be conducted. The data of parturients who gave birth to children in the past five years were collected using the hospital information system. Based on the Robson's ten group classification system, parturients were grouped. The difference of cesarean section rate in each group and its main influencing factors were then analyzed. The above factors and factors such as age, education background, and knowledge on childbirth were independent variables, while cesarean section was the dependent variable. A logistic regression model was constructed to determine the correlation between relevant influencing factors and cesarean section. RESULTS In the past 5 years, cesarean section rate in Xingtai city had been maintained at a relatively high level. Cesarean section rates in the R2 and R5 groups were the highest. Parity, fetal position, number of fetuses, and gestational weeks were all factors affecting cesarean section rate (all P < 0.01). After screening the above factors using logistic regression analysis, a regression equation was established: logistic (p) = -1.061 + 1.107 * parity + 0.196 * fetal position + 2.245 * number of fetuses - 0.070 * gestational week + 0.234 * age - 0.278 * education background + 0.623 * knowledge on childbirth. CONCLUSION The Robson classification system plays an important role in evaluating and supervising parturients' conditions. Based on the Robson classification system, we find that parity, fetal position, number of fetuses, and gestational weeks are the main factors influencing cesarean section rate. Using logistic regression analysis, a prediction model, with guiding significance on the control of cesarean section rate, is established.
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Affiliation(s)
- Wei Dong
- Department of Obstetrics and Gynecology, Xingtai People's Hospital Xingtai, Hebei Province, China
| | - Shasha Xie
- Department of Obstetrics and Gynecology, Xingtai People's Hospital Xingtai, Hebei Province, China
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Sohail R, Ferdous J, Chowdhury S, Hassan L, Woodbury L, Jamal N, Baral G, Babak S, Wasim T, Ratnasiri UDP, ur Rehman A. Examining the Efficacy of the Robson Classification System for Optimizing Cesarean Section Rates in South Asia. JOURNAL OF SOUTH ASIAN FEDERATION OF OBSTETRICS AND GYNAECOLOGY 2021; 12:366-371. [DOI: 10.5005/jp-journals-10006-1846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
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Cesarean delivery in low- and middle-income countries: A review of quality of care metrics and targets for improvement. Semin Fetal Neonatal Med 2021; 26:101199. [PMID: 33546999 PMCID: PMC8026747 DOI: 10.1016/j.siny.2021.101199] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Improving quality of care in low-and middle-income countries (LMICs) is a global priority, specifically around maternal and newborn care, where mortality and morbidity remain unacceptably high. Cesarean delivery is the most common procedure in women, thus evaluating quality around the provision of this intervention provides insight into overall quality of care around childbirth. In this review we provide an overview on the quality of care around cesarean delivery using the six domains of quality proposed by the Institute of Medicine: equity, effectiveness, efficiency, safety, timeliness and patient-centered care. We review evidence of potential quality gaps in each of these domains around cesarean delivery in LMICs, discuss opportunities for improvement and provide suggestions on metrics for tracking quality in each of these domains. As cesarean delivery rates increase globally, efforts to ensure quality will be essential to drive continued and sustained improvements in global maternal and newborn outcomes.
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