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Yosef AH, Youssef AEA, Abbas AM, Mohamed AA, Mostafa SM, Ibrahim MN. The use of ultrasound sliding sign for prediction of adhesions in women undergoing repeated caesarean section. J OBSTET GYNAECOL 2023; 43:2114333. [PMID: 36018253 DOI: 10.1080/01443615.2022.2114333] [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: 01/06/2023]
Abstract
We carried out this study to validate the use of ultrasound sliding sign to predict intraperitoneal adhesions in women undergoing repeated caesarean section (CS). A cross-section study was performed in women with at least one CS scheduled for an elective CS. We used the sliding sign of the uterus against the anterior abdominal wall to assess intraperitoneal adhesions, positive sliding sign if uterus moved freely and a negative sliding sign if limited mobility. The obstetrician was blind to the ultrasound results, asked to report if adhesions were absent or present during CS to validate accuracy of the sliding sign. We examined 120 women, negative sliding was reported in 54 patients, positive sliding in 66 women. The presence of intra-abdominal adhesions was confirmed in 44/54 cases assigned to the high-risk group, while the prediction of low risk for adhesions confirmed in 66/66 patients with a sensitivity of 100%, specificity of 86.84%. Sliding sign is an effective method to detect intra-abdominal adhesions in women with a history of repeated caesarean delivery.Impact statementWhat is already known on this subject? There has been a dramatic increase in the caesarean section (CS) rate worldwide; repeated CSs may be associated with intraperitoneal adhesions that result in difficulty during the procedure and may be related to bowel or bladder injuries and neonatal morbidities.What do the results of this study add? The sliding sign by ultrasound has a sensitivity of 100%, specificity of 86.84%, a positive predictive value of 81.5, a negative predictive value of 100, and accuracy of 91.67, considering it rapid, easy and reliable method for prediction of intraperitoneal adhesions.What are the implications of these findings for clinical practice and/or future research? The use of sliding sign by ultrasound in cases with repeated CSs offers a good predictor tool for presence of intraperitoneal adhesions and subsequently avoid severe sequels during surgery and good preparation.
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Affiliation(s)
- Ali H Yosef
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Alaa Eldin A Youssef
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed A Mohamed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Shimaa M Mostafa
- El-Eman Specialized Hospital of Obstetrics and Gynecology, Assiut Governorate, Assiut, Egypt
| | - Mostafa N Ibrahim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Akoijam B, Janani L, Christina S, Nameirakpam D, Laiphrakpam R. Analysis of cesarean section rates and its indications using robson's classification at a tertiary care hospital, Manipur. Indian J Public Health 2022; 66:434-438. [PMID: 37039169 DOI: 10.4103/ijph.ijph_1928_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Context The World Health Organization proposed the Robson's classification system as a global standard for assessing and comparing cesarean section (CS) rates within health-care facilities over time and between facilities. Aims This study aims to assess the frequency and indications of CS and to identify the groups within the obstetric population contributing to CS using Robson's classification. Settings and Design A retrospective chart review was conducted in a Tertiary Care Teaching Hospital in Imphal, Manipur. Methods All women who delivered between January and December 2019 were classified using the Robson's Ten Group Classification System. The overall CS rate and the CS rate in each Robson's group were calculated. The indications for CS were also recorded. Statistical Analysis Used Descriptive statistics, such as frequency, percentage, mean, and standard deviation, was used. Results A total of 10,282 births were reported. The overall CS rate was 35.2%. Group 3 (multiparous women without previous CS in spontaneous labor) (27.6%) and Group 1 (nulliparous women in spontaneous labor) (23.7%) contributed to most of the obstetric populations. The majority of CS belonged to the women in Group 5 (multiparous women with previous lower segment CS) (11%), followed by Group 2 (nulliparous women with labor induced or prelabor CS) (8.6%) and Group 4 (multiparous women without previous CS were induced or taken for prelabor CS) (5.5%). Conclusions The study revealed that Groups 5, 2, and 4 contributed to the high CS rate. Efforts to reduce the overall CS rate should be directed at increasing vaginal births after CS, performing effective pelvic examinations, and encouraging obstetricians to perform versions when indicated.
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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: 3] [Impact Index Per Article: 1.0] [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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An evaluation of cesarean rate in turkey by the Robson ten group classification system: How to reduce cesarean rates? JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.805389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abdo AA, Hinderaker SG, Tekle AG, Lindtjørn B. Caesarean section rates analysed using Robson's 10-Group Classification System: a cross-sectional study at a tertiary hospital in Ethiopia. BMJ Open 2020; 10:e039098. [PMID: 33115900 PMCID: PMC7594350 DOI: 10.1136/bmjopen-2020-039098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the caesarean section (CS) rates using Robson's 10-Group Classification System among women who gave birth at Hawassa University Referral Hospital in southern Ethiopia. DESIGN Cross-sectional study design to determine CS rate using Robson's 10-Group Classification System. SETTING Hawassa University Referral Hospital in south Ethiopia. PARTICIPANTS 4004 women who gave birth in Hawassa University Referral Hospital from June 2018 to June 2019. RESULTS The 4004 women gave birth to 4165 babies. The overall CS rate was 32.8% (95% CI: 31.4%-34.3%). The major contributors to the overall CS rates were: Robson group 1 (nulliparous women with singleton pregnancy at term in spontaneous labour) 22.9%; group 5 (multiparous women with at least one previous CS) 21.4% and group 3 (multiparous women without previous CS, with singleton pregnancy in spontaneous labour) 17.3%. The most commonly reported indications for CS were 'fetal compromise' (35.3%) followed by previous CS (20.3%) and obstructed labour (10.7%). CONCLUSION A high proportion of women giving birth at this hospital were given a CS, and many of them were in a low-risk group. Few had trial of labour. More active use of partogram, improving fetal heartbeat-monitoring system, implementing midwife-led care, involving a companion during labour and auditing the appropriateness of CS indications may help to reduce the CS rate.
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Affiliation(s)
- Abdella Amano Abdo
- Epidemiology, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | | | | | - Bernt Lindtjørn
- Center for International Health, University of Bergen, Bergen, Norway
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Palacios-Marques AM, Quijada-Cazorla MA, Marcos-Sanmartin J, Garcia-Villalba A, Perez-Silvestre L, Jimenez-Martinez MD, Martinez-Escoriza JC. Rationalisation of the caesarean section rate in a tertiary referral hospital using the Robson classification. J OBSTET GYNAECOL 2020; 41:200-206. [PMID: 32172631 DOI: 10.1080/01443615.2020.1718625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of this study was to implement the Robson Ten Groups Classification System (RTGCS) to identify the main contributors to the caesarean section (CS) rate and to evaluate whether the introduction of a plan of obstetrical interventions reduced this rate. An observational retrospective cross-sectional study was conducted during two time periods at Alicante University General Hospital. In the pre-implementation period (2009-2012), RTGCS was applied to identify the main groups contributing to the overall CS rate. In the post-implementation period (2013-2017), RTGCS was applied again to identify changing trends in CS rates. In all, 11,034 deliveries during the pre-intervention period and 11,453 during the post-intervention period were analysed. The overall CS rate was 23.9% and 20.9%, respectively. There were no changes in perinatal outcomes. In the post-intervention period, there was a significant decrease of the CS rate in the groups of targeted interventions 1, 2, 3, 4, 5, and 8B.Impact statementWhat is already known on this subject? High CS rates are becoming a public health problem because of risks, costs, excessive medicalisation, and abuse of resources. RTGCS provides a framework for auditing and analysing CS rates.What do the results of this study add? RTGCS can identify the groups that have the greatest impact on the CS rate and monitor changes in it consequent to policy changes.What are the implications of these findings for clinical practice? The introduction of a strategic plan with evidence-based clinical interventions may have a greater effect on the CS rate than other features justifying the increase in the incidence of CS.
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Affiliation(s)
- Ana Maria Palacios-Marques
- Obstetrics and Gynecology Department, Alicante University General Hospital, Alicante, Spain.,Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.,Department of Public Health, History of Science and Gynecology, Miguel Hernández University of Elche, Campus of San Juan, Alicante, Spain
| | - Maria Asunción Quijada-Cazorla
- Obstetrics and Gynecology Department, Alicante University General Hospital, Alicante, Spain.,Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Josefa Marcos-Sanmartin
- Obstetrics and Gynecology Department, Alicante University General Hospital, Alicante, Spain.,Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.,Department of Public Health, History of Science and Gynecology, Miguel Hernández University of Elche, Campus of San Juan, Alicante, Spain
| | - Alejandra Garcia-Villalba
- Obstetrics and Gynecology Department, Alicante University General Hospital, Alicante, Spain.,Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Lucia Perez-Silvestre
- Obstetrics and Gynecology Department, Alicante University General Hospital, Alicante, Spain.,Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Maria Dolores Jimenez-Martinez
- Obstetrics and Gynecology Department, Alicante University General Hospital, Alicante, Spain.,Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Juan Carlos Martinez-Escoriza
- Obstetrics and Gynecology Department, Alicante University General Hospital, Alicante, Spain.,Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.,Department of Public Health, History of Science and Gynecology, Miguel Hernández University of Elche, Campus of San Juan, Alicante, Spain
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Mohd Faizal A, Sharifah Raihan SK, Yulianty A, Mahdy Zaleha A. The modified Ten-Group Robson Classification: a single center's way to improve cesarean section rate. MINERVA GINECOLOGICA 2019; 71:387-390. [PMID: 31698893 DOI: 10.23736/s0026-4784.19.04416-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ahmad Mohd Faizal
- Department of Obstetrics and Gynecology, UKM Medical Center, Cheras, Kuala Lumpur, Malaysia -
| | | | - Ariffudin Yulianty
- Department of Obstetrics and Gynecology, UKM Medical Center, Cheras, Kuala Lumpur, Malaysia
| | - Abdullah Mahdy Zaleha
- Department of Obstetrics and Gynecology, UKM Medical Center, Cheras, Kuala Lumpur, Malaysia
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Wen J, Chen Q, Luo Q. Analysing the likelihood of caesarean birth after implementation of the two-childbirth policy in China, using the Ten Group Classification System. J OBSTET GYNAECOL 2019; 40:336-341. [PMID: 31354082 DOI: 10.1080/01443615.2019.1624949] [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: 10/26/2022]
Abstract
The aim of this study was to identify the main contributor to the high Caesarean section birth rate at a regional perinatal medical centre using the Robson Ten Group Classification System (TGCS). A total of 54,085 women were surveyed and were included in our study from 2015 to 2017 at the Women's Hospital at Zhejiang University School of Medicine in Hangzhou, China. The Caesarean birth rate was similar among the three years; although, the new two-childbirth policy in China has been in implementation since 2016. According to the TGCS, Group 5 was the largest contributor to the overall Caesarean birth rate (40.79%), followed by Group 2 (21.36%). The Caesarean birth rate of Group 5 and Group 2 decreased significantly from 2015 to 2017 (p < .05). The proportion of Group 7 contributing to the overall Caesarean birth rate increased significantly (p < .05). Future efforts should focus on increasing vaginal birth after Caesarean in Group 5 and external cephalic version in Group 7 to decrease the overall Caesarean birth rate.Impact statementWhat is already known on this subject? The Ten Group Classification System (TGCS) proposed by World Health Organisation was used in some countries such as Queensland, Singapore and Japan to assess and compare Caesarean section rates. The main contributor to the high Caesarean birth rate varies in different counties. However, it is not widely used in China.What the results of this study add? It was the first study using the TGCS to analyse the Caesarean birth rate and the changes after implementation of the two-childbirth policy in China. It identified that Group 5 (multiparous mothers with a previous Caesarean birth in a singleton, cephalic full-term pregnancy) constituted the most important determinant of overall Caesarean birth rates, followed by Group 2 (nulliparous mothers with a singleton, cephalic full-term pregnancy undergoing an induction of labour or prelabour Caesarean birth). The contribution of Group 5 and Group 7 (multiparous women with a single breech pregnancy) to the overall Caesarean birth rate has increased significantly since the new childbirth policy was implemented.What the implications are of these findings for clinical practice and/or further research? Future efforts should focus on increasing vaginal birth after Caesarean in Group 5 and external cephalic version in Group 7 to decrease the overall Caesarean birth rate in China.
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Affiliation(s)
- Jie Wen
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - QinQing Chen
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiong Luo
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Pregnancy outcomes of women with previous caesarean sections: Secondary analysis of World Health Organization Multicountry Survey on Maternal and Newborn Health. Sci Rep 2019; 9:9748. [PMID: 31278298 PMCID: PMC6611838 DOI: 10.1038/s41598-019-46153-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 06/24/2019] [Indexed: 11/22/2022] Open
Abstract
Secondary analysis of World Health Organization Multicountry Survey on Maternal and Newborn Health (WHOMCS) was undertaken among 173,124 multiparous women to assess the association between previous caesarean sections (CS) and pregnancy outcomes. Maternal outcomes included maternal near miss (MNM), maternal death (MD), severe maternal outcomes (SMO), abnormal placentation, and uterine rupture. Neonatal outcomes were stillbirth, early neonatal death, perinatal death, neonatal near miss (NNM), neonatal intensive care unit (NICU) admission, and preterm birth. Previous CS was associated with increased risks of uterine rupture (adjusted Odds Ratio (aOR); 7.74; 95% confidence interval (CI) 5.48, 10.92); morbidly adherent placenta (aOR 2.60; 95% CI 1.98, 3.40), MNM (aOR 1.91; 95% CI 1.59, 2.28), SMO (aOR 1.80; 95% CI 1.52, 2.13), placenta previa (aOR 1.76; 95% CI 1.49, 2.07). For neonatal outcomes, previous CS was associated with increased risks of NICU admission (aOR 1.31; 95% CI 1.23, 1.39), neonatal near miss (aOR 1.19; 95% CI 1.12, 1.26), preterm birth (aOR 1.07; 95% CI 1.01, 1.14), and decreased risk of macerated stillbirth (aOR 0.80; 95% CI 0.67, 0.95). Previous CS was associated with serious morbidity in future pregnancies. However, these findings should be cautiously interpreted due to lacking data on indications of previous CS.
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Haider MR, Rahman MM, Moinuddin M, Rahman AE, Ahmed S, Khan MM. Ever-increasing Caesarean section and its economic burden in Bangladesh. PLoS One 2018; 13:e0208623. [PMID: 30532194 PMCID: PMC6287834 DOI: 10.1371/journal.pone.0208623] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 11/20/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cesarean Section (CS) delivery has been increasing rapidly worldwide and Bangladesh is no exception. In Bangladesh, the CS rate has increased from about 3% in 2000 to about 24% in 2014. This study examines trend in CS in Bangladesh over the last fifteen years and implications of this increasing CS rates on health care expenditures. METHODS Birth data from Bangladesh Demographic and Health Survey (BDHS) for the years 2000-2014 have been used for the trend analysis and 2010 Bangladesh Maternal Mortality Survey (BMMS) data were used for estimating health care expenditure associated with CS. RESULTS Although the share of institutional deliveries increased four times over the years 2000 to 2014, the CS deliveries increased eightfold. In 2000, only 33% of institutional deliveries were conducted through CS and the rate increased to 63% in 2014. Average medical care expenditure for a CS delivery in Bangladesh was about BDT 22,085 (USD 276) in 2010 while the cost of a normal delivery was BDT 3,565 (USD 45). Health care expenditure due to CS deliveries accounted for about 66.5% of total expenditure on all deliveries in Bangladesh in 2010. About 10.3% of Total Health Expenditure (THE) in 2010 was due to delivery costs, while CS costs contribute to 6.9% of THE and rapid increase in CS deliveries will mean that delivering babies will represent even a higher proportion of THE in the future despite declining crude birth rate. CONCLUSION High CS delivery rate and the negative health outcomes associated with the procedure on mothers and child births incur huge economic burden on the families. This is creating inappropriate allocation of scarce resources in the poor economy like Bangladesh. Therefore it is important to control this unnecessary CS practices by the health providers by introducing litigation and special guidelines in the health policy.
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Affiliation(s)
- Mohammad Rifat Haider
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Mohammad Masudur Rahman
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Moinuddin
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Statistical Science, University of Padova, Padova, Italy
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - M. Mahmud Khan
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
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Kacerauskiene J, Bartuseviciene E, Railaite DR, Minkauskiene M, Bartusevicius A, Kliucinskas M, Simoliuniene R, Nadisauskiene RJ. Implementation of the Robson classification in clinical practice:Lithuania's experience. BMC Pregnancy Childbirth 2017; 17:432. [PMID: 29262810 PMCID: PMC5738883 DOI: 10.1186/s12884-017-1625-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/12/2017] [Indexed: 12/04/2022] Open
Abstract
Background To determine the cesarean section (CS) rate in Lithuania, identify the groups of women that influence it using the Robson classification and to determine the impact of implementing the use of the Robson classification on the CS rate. Methods The Robson classification was introduced in Lithuanian hospitals prospectively classifying all the deliveries in 2012. The overall CS rate, sizes of the Robson groups of women, CS rate in each group and contribution to the overall CS rate from each group was calculated and the results were discussed. The analysis was repeated in 2014 and the data were compared using MS EXCEL and SPSS 23.0. Results Nineteen Lithuanian hospitals participated in the study. They represented 84.1% of the deliveries (23,742 out of 28,230) in 2012 and 88.5% of the deliveries (24,653 out of 27,872) in 2014. The CS rate decreased from 26.9% (6379/23,742) in 2012 to 22.7% (5605/24,653) in 2014 (p < 0.001). The greatest contributions to the overall CS rate were made by groups 1, 2 and 5. The greatest decrease in the CS rate was detected in group 2. The absolute contribution to the overall CS rate decreased from 4.9% to 3.8%. Conclusion The Robson classification can work as an audit tool to identify the groups that have the greatest impact on the CS rate. It also helps to develop a strategy focussing on the reduction of the CS rate.
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Affiliation(s)
| | - Egle Bartuseviciene
- Lithuanian University of Health Sciences, Eiveniu str. 2, 50167, Kaunas, Lithuania
| | | | - Meile Minkauskiene
- Lithuanian University of Health Sciences, Eiveniu str. 2, 50167, Kaunas, Lithuania
| | | | | | - Renata Simoliuniene
- Lithuanian University of Health Sciences, Eiveniu str. 2, 50167, Kaunas, Lithuania
| | - Ruta J Nadisauskiene
- Lithuanian University of Health Sciences, Eiveniu str. 2, 50167, Kaunas, Lithuania
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Kankoon N, Lumbiganon P, Kietpeerakool C, Sangkomkamhang U, Betrán AP, Robson M. Cesarean rates and severe maternal and neonatal outcomes according to the Robson 10-Group Classification System in Khon Kaen Province, Thailand. Int J Gynaecol Obstet 2017; 140:191-197. [PMID: 29094345 DOI: 10.1002/ijgo.12372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/23/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess cesarean rates and maternal and neonatal outcomes in each group in the Robson 10-Group Classification System (TGCS). METHODS In a cross-sectional study, data were reviewed from all pregnant women who delivered at 24 government hospitals in Khon Kaen Province, Thailand, in 2014. Delivery and perinatal outcomes were recorded. RESULTS Of 18 043 deliveries, 5666 (31.4%) were by cesarean. Women in group 5 (previous cesarean) accounted for the most cesareans (1472, 26.0%). Groups 1 and 2 (nulliparous women) accounted for 2355 (41.6%) of procedures; the rate of cesarean within these two groups was 19.4% (1162/5981) and 71.2% (1193/1675), respectively. As compared with group 1, women in groups 2, 4, 6, 7, and 10 had significantly increased risk of severe maternal outcomes, and those in groups 6, 7, 8, 9, and 10 had an increased risk of severe neonatal outcomes. CONCLUSION The rate of cesarean in the study setting was high, and three out of four procedures were performed for women in groups 5, 1, and 2. Interventions should be focused on these groups to reduce the overall cesarean rates.
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Affiliation(s)
- Natthapong Kankoon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chumnan Kietpeerakool
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Ana P Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Tsai HT, Wu CH. Vaginal birth after cesarean section-The world trend and local experience in Taiwan. Taiwan J Obstet Gynecol 2017; 56:41-45. [PMID: 28254224 DOI: 10.1016/j.tjog.2016.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The trend of increasing cesarean section rates had evoked worldwide attention. Many approaches were introduced to diminish cesarean section rates. Vaginal birth after cesarean section (VBAC) is a route of delivery with diverse agreements. In this study, we try to reveal the world trend in VBAC and our experience of a 10-year period in a medical center in northern Taiwan. MATERIALS AND METHODS This is a retrospective study of all women who underwent elective repeat cesarean delivery or trial of labor after cesarean (TOLAC) following primary cesarean delivery by a general obstetrician-gynecologist in the Tamshui Branch of MacKay Memorial Hospital (Taipei, Taiwan) between 2006 and 2015. We excluded cases of preterm labor, two or more cesarean deliveries, and major maternal diseases. We compared the characteristics and outcomes between these groups. RESULTS We included 400 women with subsequent pregnancies who underwent elective repeat cesarean delivery or TOLAC during the study period. Among the study population, 112 women were excluded and 11 underwent repeat VBAC. A total of 204 (73.65%) cases underwent elective repeat cesarean delivery and 73 (26.35%) chose TOLAC. The rate of successful VBAC among the women who chose TOLAC was 84.93%. CONCLUSION With respect to maternal and fetal safety, and success rates and adverse effects of VBAC, the results of this study are promising and compatible with the global data. It shows that a trial of VBAC can be offered to pregnant women without contraindications with high success rates.
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Affiliation(s)
- Hsiu-Ting Tsai
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chia-Hsun Wu
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.
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Abdel-Aleem H, Darwish A, Abdelaleem AA, Mansur M. Usefulness of the WHO C-Model to optimize the cesarean delivery rate in a tertiary hospital setting. Int J Gynaecol Obstet 2017; 137:40-44. [PMID: 28099759 DOI: 10.1002/ijgo.12092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/22/2016] [Accepted: 01/03/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess use of the C-Model in a tertiary hospital setting in terms of its validity and utility for optimizing the cesarean delivery (CD) rate. METHODS A prospective observational study included women admitted for delivery at a university teaching hospital in Assiut, Egypt, in 2015. The women were asked about the demographic and obstetric information needed to calculate the probability of CD using the WHO C-Model. A receiver operating characteristic (ROC) curve comparing the predicted and observed CD rates was constructed. In addition, the mean predicted CD rates were compared with the mean observed CD rates in the 10 groups of the Robson classification. RESULTS In total, 1000 women were recruited; 38.6% had a previous CD and 13.5% had complications during the current pregnancy. The final mode of delivery was vaginal delivery in 38.7% and CD in 61.3%; the predicted CD rate for this cohort was 45.0%. The area under the ROC curve was 0.928 (95% confidence interval 0.912-0.945). Comparison of the predicted and observed CD rates in the 10 Robson groups showed an overuse of CD ranging from 2% to 50%. CONCLUSION The WHO C-Model is valid and can be used in hospital settings to optimize CD rates.
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Affiliation(s)
- Hany Abdel-Aleem
- Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut, Egypt
| | - Atef Darwish
- Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut, Egypt
| | - Ahmad A Abdelaleem
- Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut, Egypt
| | - Manal Mansur
- Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut, Egypt
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Gerli S, Favilli A, Franchini D, De Giorgi M, Casucci P, Parazzini F. Is the Robson's classification system burdened by obstetric pathologies, maternal characteristics and assistential levels in comparing hospitals cesarean rates? A regional analysis of class 1 and 3. J Matern Fetal Neonatal Med 2017; 31:173-177. [PMID: 28056581 DOI: 10.1080/14767058.2017.1279142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess if maternal risk profile and Hospital assistential levels were able to influence the inter-Hospitals comparison in the class 1 and 3 of the "The Ten Group Classification System" (TGCS). METHODS A population-based analysis using data from Institutional data-base of an Italian Region was carried out. The 11 maternity wards were divided into two categories: second-level hospitals (SLH), and first-level hospitals (FLH). The recorded deliveries were classified according to the TGCS. To analyze if different maternal characteristics and the hospitals assistential level could influence the cesarean section (CS) risk, a multivariate analysis was done considering separately women in the TGCS class 1 and 3. RESULTS From January 2011 to December 2013 were recorded 19,987 deliveries. Of those 7,693 were in the TGCS class 1 and 4,919 in the class 3. The CS rates were 20.8% and 14.7% in class 1 (p < 0.0001) and 6.9% and 5.3% (p < 0.0230) in class 3, respectively in the FLH and SLH. The multivariate logistic regression showed that the FLH, older maternal age and gestational diabetes were independent risk factors for CS in groups 1 and 3. Obesity and gestational hypertension were also independent risk factors for group 1. CONCLUSIONS TGCS is a useful tool to analyze the incidence of CS in a single center but in comparing different Hospitals, maternal characteristics and different assistential levels should be considered as potential bias.
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Affiliation(s)
- Sandro Gerli
- a Department of Obstetrics and Gynecology , University of Perugia , S. Andrea delle Fratte , Perugia , Italy
| | - Alessandro Favilli
- a Department of Obstetrics and Gynecology , University of Perugia , S. Andrea delle Fratte , Perugia , Italy
| | | | | | - Paola Casucci
- c Regione Umbria , Direzione Regionale Salute , Perugia , Italy
| | - Fabio Parazzini
- d Dipartimento Materno Infantile, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Università di Milano , Milan , Italy.,e Dipartimento di Scienze Cliniche e di Comunità , Universita' di Milano , Milan , Italy
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Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One 2016; 11:e0148343. [PMID: 26849801 PMCID: PMC4743929 DOI: 10.1371/journal.pone.0148343] [Citation(s) in RCA: 1135] [Impact Index Per Article: 141.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/15/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Caesarean section (CS) rates continue to evoke worldwide concern because of their steady increase, lack of consensus on the appropriate CS rate and the associated additional short- and long-term risks and costs. We present the latest CS rates and trends over the last 24 years. METHODS We collected nationally-representative data on CS rates between 1990 to 2014 and calculated regional and subregional weighted averages. We conducted a longitudinal analysis calculating differences in CS rates as absolute change and as the average annual rate of increase (AARI). RESULTS According to the latest data from 150 countries, currently 18.6% of all births occur by CS, ranging from 6% to 27.2% in the least and most developed regions, respectively. Latin America and the Caribbean region has the highest CS rates (40.5%), followed by Northern America (32.3%), Oceania (31.1%), Europe (25%), Asia (19.2%) and Africa (7.3%). Based on the data from 121 countries, the trend analysis showed that between 1990 and 2014, the global average CS rate increased 12.4% (from 6.7% to 19.1%) with an average annual rate of increase of 4.4%. The largest absolute increases occurred in Latin America and the Caribbean (19.4%, from 22.8% to 42.2%), followed by Asia (15.1%, from 4.4% to 19.5%), Oceania (14.1%, from 18.5% to 32.6%), Europe (13.8%, from 11.2% to 25%), Northern America (10%, from 22.3% to 32.3%) and Africa (4.5%, from 2.9% to 7.4%). Asia and Northern America were the regions with the highest and lowest average annual rate of increase (6.4% and 1.6%, respectively). CONCLUSION The use of CS worldwide has increased to unprecedented levels although the gap between higher- and lower-resource settings remains. The information presented is essential to inform policy and global and regional strategies aimed at optimizing the use of CS.
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Affiliation(s)
- 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, Geneva, Switzerland
| | - Jianfeng Ye
- Department of Clinical Epidemiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Anne-Beth Moller
- 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, Geneva, Switzerland
| | - Jun Zhang
- Ministry of Education—Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - A. Metin Gülmezoglu
- 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, Geneva, Switzerland
| | - Maria Regina Torloni
- Evidence Based Healthcare Post-Graduate Program, Department of Medicine, São Paulo Federal University, São Paulo, Brazil
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Caesarean Section in Peru: Analysis of Trends Using the Robson Classification System. PLoS One 2016; 11:e0148138. [PMID: 26840693 PMCID: PMC4740461 DOI: 10.1371/journal.pone.0148138] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/13/2016] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Cesarean section rates continue to increase worldwide while the reasons appear to be multiple, complex and, in many cases, country specific. Over the last decades, several classification systems for caesarean section have been created and proposed to monitor and compare caesarean section rates in a standardized, reliable, consistent and action-oriented manner with the aim to understand the drivers and contributors of this trend. The aims of the present study were to conduct an analysis in the three Peruvian geographical regions to assess levels and trends of delivery by caesarean section using the Robson classification for caesarean section, identify the groups of women with highest caesarean section rates and assess variation of maternal and perinatal outcomes according to caesarean section levels in each group over time. MATERIAL AND METHODS Data from 549,681 pregnant women included in the Peruvian Perinatal Information System database from 43 maternal facilities in three Peruvian geographical regions from 2000 and 2010 were studied. The data were analyzed using the Robson classification and women were studied in the ten groups in the classification. Cochran-Armitage test was used to evaluate time trends in the rates of caesarean section rates and; logistic regression was used to evaluate risk for each classification. RESULTS The caesarean section rate was 27% and a yearly increase in the overall caesarean section rates from 2000 to 2010 from 23.5% to 30% (time trend p<0.001) was observed. Robson groups 1, 3 (nulliparous and multiparas, respectively, with a single cephalic term pregnancy in spontaneous labour), 5 (multiparas with a previous uterine scar with a single, cephalic, term pregnancy) and 7 (multiparas with a single breech pregnancy with or without previous scars) showed an increase in the caesarean section rates over time. Robson groups 1 and 3 were significantly associated with stillbirths (OR 1.43, CI95% 1.17-1.72; OR 3.53, CI95% 2.95-4.2) and maternal mortality (OR 3.39, CI95% 1.59-7.22; OR 8.05, CI95% 3.34-19.41). DISCUSSION The caesarean section rates increased in the last years as result of increased CS in groups with spontaneous labor and in-group of multiparas with a scarred uterus. Women included in groups 1 y 3 were associated to maternal perinatal complications. Women with previous cesarean section constitute the most important determinant of overall cesarean section rates. The use of Robson classification becomes an useful tool for monitoring cesarean section in low human development index countries.
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Lembrouck C, Mottet N, Bourtembourg A, Ramanah R, Riethmuller D. [Can we decrease cesarean rate at a university hospital treating high risk pregnancies?]. ACTA ACUST UNITED AC 2015; 45:641-51. [PMID: 26433437 DOI: 10.1016/j.jgyn.2015.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/01/2015] [Accepted: 08/25/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine which clinical practice changes were responsible for a decrease in cesarean rate from 19.2% in 2003 to 15.5% in 2012 at our university hospital treating high risk pregnancies, while verifying the absence of any increase in neonatal morbidity and death. MATERIALS AND METHODS A descriptive retrospective study was undertaken at our labour ward including all patients delivering in 2003 and in 2012. Maternal, obstetrical and neonatal characteristics of the two populations were compared. Cesarean rates were analysed following : (1) Robson classification, (2) some maternal and obstetrical characteristics, and (3) indications for cesarean. RESULTS Mean age, BMI and rate of scarred uterus significantly increased in 2012. The two populations remained comparable in terms of other criteria studied. The main cause responsible for decrease in cesarean rate was breech presentations (p<0.05). Furthermore, significantly less cesareans were performed after labour induction (p=0.04). We also significantly decreased our elective cesarean rate by more than 3% without increasing cesarean sections during labour, showing a rise in successful vaginal delivery trials. The impact of in utero transfers on the global rate of cesarean is highly significant since the latter has been divided by half in 10 years in this population considered to be of high risk for cesareans. DISCUSSION These significant decreases reflect our experience in allowing vaginal deliveries in breech presentations, and also a better selection of patients for labour induction. Furthermore, it should be noted that increasing vaginal delivery trials in various obstetrical situations participated in this decrease. We clearly found that some indications for elective cesarean can be avoided, such as multiple pregnancies and scarred uterus, thus showing the importance of restricting the first indication for cesarean. Finally, the decrease in cesarean rate had no negative effect on neonatal outcome. CONCLUSION Decreasing cesarean rate is possible in a university hospital treating high risk pregnancies. It requires daily obstetrical case by case critical analysis, allowing wide acceptance of vaginal delivery trials, and continuously evaluating clinical practices.
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Affiliation(s)
- C Lembrouck
- Pôle mère-femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - N Mottet
- Pôle mère-femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - A Bourtembourg
- Pôle mère-femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - R Ramanah
- Pôle mère-femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - D Riethmuller
- Pôle mère-femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France.
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Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, Tunçalp Ö, Mori R, Morisaki N, Ortiz-Panozo E, Hernandez B, Pérez-Cuevas R, Qureshi Z, Gülmezoglu AM, Temmerman M. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. LANCET GLOBAL HEALTH 2015; 3:e260-70. [DOI: 10.1016/s2214-109x(15)70094-x] [Citation(s) in RCA: 718] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Ferreira EC, Pacagnella RC, Costa ML, Cecatti JG. The Robson ten-group classification system for appraising deliveries at a tertiary referral hospital in Brazil. Int J Gynaecol Obstet 2015; 129:236-9. [PMID: 25704253 DOI: 10.1016/j.ijgo.2014.11.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/25/2014] [Accepted: 02/02/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the distribution of women according to the Robson 10-group classification system (RTGCS) and the occurrence of severe maternal morbidity (SMM) by mode of delivery at a tertiary referral hospital. METHODS A retrospective cross-sectional study was conducted of all women admitted to the Women's Hospital at the University of Campinas (Campinas, Brazil) for delivery between January 2009 and July 2013. Women were grouped according to RTGCS. Mode of delivery and SMM (defined as need for admission to the intensive care unit) were assessed. RESULTS Among 12 771 women, 5957 (46.6%) delivered by cesarean. Overall, 3594 (28.1%) women were in group 1 (nulliparous, single pregnancy, cephalic, term, spontaneous labor), 2328 (18.2%) in group 5 (≥1 previous cesarean, single pregnancy, cephalic, term), and 2112 (16.5%) in group 3 (multiparous excluding previous cesarean, single pregnancy, cephalic, term, spontaneous labor). Group 5 contributed the most cesarean deliveries (1626 [27.3%]), followed by group 2 (nulliparous, single pregnancy, cephalic, term, induced labor or cesarean before labor; 1049 [17.6%]). SMM was more common among women undergoing cesarean delivery than among those delivering vaginally in groups 1-5. CONCLUSION The RTGCS allowed the identification of groups with the highest frequency of cesarean delivery and an assessment of SMM. This should be considered in related health policies.
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Affiliation(s)
- Elton C Ferreira
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Maria L Costa
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Jose G Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.
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