Changing trends in cesarean section deliveries in a tertiary hospital using the Robson Ten Group Classification

Öz

Objective: This study aimed to identify and highlight the changing trends in cesarean deliveries in a tertiary hospital using the Robson Ten Group Classification Method: A retrospective cohort study included 103745 patients admitted to Istanbul Kanuni Training and Research Hospital's Obstetrics and Gynecology Department between January 1, 2012, and December 31, 2021. Ten groups were established based on five basic obstetric factors: parity, labor initiation, gestational age, number of fetuses, and fetal presentation. All live or dead births over 500 g or 20 gestational weeks were included in the study. Women with missing file information were excluded from the study. Total number of cesarean sections in the group, total number of women in each group, group size (%), group cesarean rate (%), absolute group contribution to general cesarean section rate (%) group contribution relative to general cesarean section rate (%) were calculated. Cesarean section indications were evaluated in 10 categories and their numbers and rates were recorded. Statistical analyzes were performed using SPSS version 24.0 for Windows. Results: Our study’s average CS rate from 2012 to 2021 was 45.77%. The largest contributions to the total cesarean section rate were in group 5 (20.69%), group 3 (5.99%), and group 1 (5.75%). Conclusion: In our study, Robson groups 5, 3, and 1 comprised the majority of contributors to the total cesarean section performed. Any effort to reduce the rate of CS should focus on these subgroups.

Anahtar Kelimeler

• Robson Ten Group Classification
• cesarean section
• pregnancy

Sezaryan doğum oranlarındaki değişimin üçüncü basamak bir hastanede Robson On Grup Sınıflandırması kullanılarak analizi

Öz

Amaç: Bu çalışmanın amacı, üçüncü basamak bir hastanede sezaryen doğumlardaki değişen eğilimleri Robson On Grup Sınıflandırmasını kullanarak belirlemek ve vurgulamaktı Yöntem: Bu retrospektif çalışmaya 01.01.2012 - 31.12. 2021. tarihleri arasında SBÜ İstanbul Kanuni Sultan Süleyman EA Hastanesi Kadın Hastalıkları ve Doğum polikliniğine başvuran 103745 hasta dahil edildi.. Fetüs sayısı ,parite , doğum başlangıcı ,gebelik yaşı , fetal presentasyon gibi beş temel karakteristik özelliklerine doğumlar Robson sınıflamasına göre on gruba ayrıldı. 500 gramın üzerindeki veya 20 haftanın üzerindeki ölü yada canlı tüm doğumlar çalışmaya dahil edildi. Dosya bilgileri eksik olan kadınlar çalışma dışı bırakıldı.Gruptaki toplam sezaryen sayısı, her gruptaki toplam kadın sayısı, grup büyüklüğü(%), grup sezaryen oranı (%) , genel sezaryen oranına mutlak grup katkısı (%) genel sezaryen oranına göreli grup katkısı (%) hesaplandı. Sezeryan endikasyonları 10 kategoride değerlendirilerek sayıları ve oranları kaydedildi. İstatistiksel analizler , SPSS programının Windows için 24.0 versiyonu, kullanılarak yapıldı.. Bulgular: Araştırmamızda , 2012'den 2021'e kadar ortalama CS oranı %45,77 idi. Toplam sezaryen oranına en büyük katkılar grup 5, (20.69%) , grup 3 (%5.99)ve ve grup 1(5.75% ) te idi. Sonuç: Çalışmamızda, Robson grupları 5, 3 ve 1, yapılan toplam sezaryene katkıda bulunanların çoğunluğunu oluşturdu. CS oranını düşürmeye yönelik herhangi bir çaba, bu alt gruplara odaklanmalıdır.

Anahtar Kelimeler

• Robson Ten Group Classification
• cesarean section
• pregnancy

Kaynakça

1. 1. Souza JP, Betran AP, Dumont A, et al. A global reference for cesarean section rates (C-Model): a multi-country cross-sectional study. BJOG 2016;123(3):427-36.
2. 2. Clark SL, Belfort MA, Dildy GA, Herbst MA, Meyers JA, Hankins GD. Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery. Am J Obstet Gynecol. 2008;199(1):36. e1-5.
3. 3. Villar J, Carroli G, Zavaleta N, et al. Maternal and neonatal individual risks and benefits associated with cesarean delivery: a multicentre prospective study. BMJ 2007;335:1025.
4. 4. Barčaitė E, Kemeklienė G, Railaitė DR, Bartusevičius A, Maleckienė L, Nadišauskienė R. Cesarean section rates in Lithuania using Robson Ten Group Classification System. Medicine (Kaunas) 2015; 51 (05) 280-285.
5. 5. 5.Nakamura-Pereira M, do Carmo Leal M, Esteves-Pereira AP, Domingues RMSM, Torres JA, Dias MAB, Moreira ME. Use of Robson classification to assess cesarean section rate in Brazil: the role of the source of payment for childbirth. Reprod Health 2016; 13 (Suppl. 03) 128.
6. 6. Robson MS. Classification of cesarean sections. Fetal and Maternal Medicine Review. 2001; 12 (1):23–39 7. 7.Betran AP, Torloni MR, Zhang JJ, Gülmezoglu AM.; WHO Working Group on Caesarean Section. WHO statement on cesarean section rates. BJOG 2016; 123 (05) 667-670
7. 8. FIGO Working Group on Challenges in the Care of Mothers and Infants During Labour and Delivery. Best practice advice on the 10-Group Classification System for cesarean deliveries. Int J Gynaecol Obstet 2016; 135:232–3.
8. 9. Brennan DJ, Robson MS, Murphy M, O’Herlihy C. Comparative analysis of international cesarean delivery rates using 10-group classification identifies significant variation in spontaneous labor. Am J Obstet Gynecol. 2009; 13(308): e1–e8

9. 10. Robson M, Hartigan L, Murphy M. Methods of achieving and maintaining an appropriate cesarean section rate. Best Pract Res Clin Obstet Gynecol 2013; 27(2):297–308.
10. 11. Başer E, Kırmızı DA, Özdemirci Ş, et al. An evaluation of cesarean rate in turkey by the Robson ten-group classification system: How to reduce cesarean rates? J Surg Med. 2020;4(11):1031-1035.
11. 12. Jain R, Joshi V. Analysis of the cesarean section using Robson’s ten-group classification system - a way of monitoring obstetric practice. The New Indian Journal of OBGYN. 2022; 9(1): 71-7.
12. 13. Prameela RC, Shilpa G, Farha A, Prajwal S. Analysis of Cesarean section rate using Robson’s Ten Group Classification System and comparing the trend at a tertiary hospital for 2 years. Journal of South Asian Federation of Obstetrics and Gynaecology. 2016 July Sept; 8 (3):175-80.
13. 14. Gilani S, Mazhar SB, Zafar M, Mazhar T. The modified Robson criteria for Caesarean Section audit at Mother and Child Health Center Pakistan Institute of Medical Sciences Islamabad. J Pak Med Assoc. 2020; 70(2): 299-303
14. 15. Koteshwara S, Sujatha MS. Analysis of cesarean section rates using Robson ten group classification: the first step. Int J Reprod Contracept Obstet Gynecol 2017;6:3481-5.
15. 16. Robson M, Murphy M, Byrne F. Quality assurance: The 10-Group Classification System (Robson classification), induction of labor, and cesarean delivery. Int J Gynecol Obstet 2015;131:S23-7
16. 17. Neuman M, Alcock G, Azad K, et al. Prevalence and determinants of cesarean section in private and public health facilities in underserved South Asian communities: Cross-sectional analysis of data from Bangladesh, India, and Nepal. BMJ Open 2014;4:e005982.
17. 18. Reddy AY, Dalal A, Khursheed R. Robson Ten Group Classification System for analysis of cesarean sections in an Indian Hospital. Res J Obstet Gynecol. 2018; 11(1):1-8.
18. 19. Kazmi T, Saiseema S, Khan S. Analysis of Cesarean Section Rate - According to Robson's 10-group Classification. Oman Med J. 2012; 27(5): 415-7
19. 20. Khan MA, Sohail I, Habib M. Auditing the cesarean section rate by Robson’s ten group classification system at tertiary care hospital. Professional Med J. 2020;27(4):700–706.
20. 21. Parveen, R., Khakwani, M., Naz, A., & Bhatti, R. Analysis of Cesarean Sections using Robson's Ten Group Classification System. Pak J Med Sci. 2021; 37(2): 567–571.
21. 22. Bolognani, C. V., Reis, L. B. S. M., Dias, A., & Calderon, I. M. P. (2018). Robson 10-groups classification system to access C-sections in two Federal District/Brazil public hospitals. PloS one, 13(2), e0192997.
22. 23. Carbillon L, Benbara A, Tigaizin A, et al. Revisiting the management of term breech presentation: a proposal for overcoming some of the controversies. BMC Pregnancy Childbirth. 2020;20(1):263.
23. 24. Tanaka K, Mahomed K. The Ten-Group Robson Classification: A Single Centre Approach Identifying Strategies to Optimise Caesarean Section Rates. Obstet Gynecol Int. 2017;2017:5648938.
24. 25. Buhur A, Oncu N, Erdem D. Analysis of Caesarean Section Rates with the Robson 10 Group Classification. Turk J Health S. 2022;3(2):53-57.
25. 26. Kıyak H, Bolluk G, Canaz E, Yüksel S, Gedikbaşlı A. The evaluation of cesarean section rates by the Robson Ten-Group Classification System and the data of perinatology (tertiary center). Perinatal Journal 2019;27(2):89–100