DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20163004

Analysis of caesarean delivery rates using the ten group classification system in a tertiary care hospital

Seetha Panicker, Chitra T.V.

Abstract


Background: With the increasing safety of operative delivery the caesarean section rates have been increasing steadily over the last 60 years both in the developing countries and the developed world. However efforts to analyse the rates and identify preventable causes are difficult as most units report only the overall caesarean section rates. This retrospective study was undertaken to analyse the indications for caesarean delivery in a one year period from January 1st to December 31st 2014 using the Robson’s ten group classification system to identify CS rates in each of the separate groups.

Methods: All patients who delivered between 1st January 2014 to 31st December 2014 were identified based on the parturition register and their case records were analysed for risk factors, intra-partum events, mode of delivery and the indications for caesarean section. These were classified according to the ten group classification system.

Results: Caesarean section rate was 41.5% in this period. The CS rate was lowest in Group 3 - 11.97% and 100% in Group 9 (Transverse lie). Group 5 (Previous CS) made the greatest contribution (42.77%) to the total number of CS. Analysing these rates could make comparisons over time and from different centers.

Conclusions: Strategies to reduce the CS rate should be concentrated on Group 1 and Group 2. These include a relook at definition of abnormal first stage, standardization of abnormal FHR tracings, strict policy on induction of labour and protocols for trial of labour in previous CS.


Keywords


Caesarean section rate, Ten group classification

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References


The American College of Obstetrics and gynaecology. Obstetric care consensus. 2014:1.

Arjun G, Rajasri S, Balakrishnan S. The management of labour: Arulkumaran S, Gita Arjun, Leonie K Penna. Cesarean section procedure and technique. 3rd Ed. India. Universities Press. 2011:248-65.

Robson MS. The management of labour: Arulkumaran S, Gita Arjun, Leonie K Penna. Strategies to reduce the rate of caesarean section. 3rd Ed. India. Universities Press. 2011:237-47.

Farine D, Toronto ON, Debra Shepherd MD, Regina SK. Classification of Caesarean Sections in Canada: The Modified Robson Criteria. J Obstet Gynaecol Can. 2012;34(10):976-9.

Kazmi T, Saiseema VS, Khan S. Analysis of Cesarean Section Rate: according to robson’s 10-group classification. Oman Medical Journal. 2012; 27(5):415-7.

Brennan DJ, Robson MS, Murphy M. Comparative analysis of international cesarean delivery rates using 10-group classification identifies significant variation in spontaneous labor. Am J Obstet Gynecol. 2009;201(308):1-8.

Chaillet N, Dubé E, Dugas M. Identifying barriers and facilitators towards implementing guidelines to reduce caesarean section rates in Quebec. Bulletin of the World Health Organization.

MacDorman MF, Menacker F, Declercq E. Cesarean birth in the United States: epidemiology, trends, and outcomes. Clin Perinatol. 2008;35:293-307.

Denk CE, Kruse LK, Jain NJ. Surveillance of cesarean section deliveries, New Jersey. 1999-2004. Birth. 2006;33:203-9.

Coonrod DV, Drachman D, Hobson P, Manriquez M. Nulliparous term singleton vertex cesarean delivery rates: institutional and individual level predictors. Am J Obstet Gynecol. 2008;198:694.e1-11.

Jonsdottir G, Smarason AK, Geirsson RT, Bjarnadottir RI. No correlation between cesarean section rates and perinatal mortality of singleton infants over 2,500 g. Acta Obstet Gynecol Scand. 2009;88:621-3.

Turcot L, Marcoux S, Fraser WD. Multivariate analysis of risk factors for operative delivery in nulliparous women. Canadian Early Amniotomy Study Group. Am J Obstet Gynecol. 1997;176:395-402.

Thomas J, Callwood A, Brocklehurst P, Walker J. The National Sentinel Caesarean Section Audit. BJOG. 2000;107:579-80.

Wilkes PT, Wolf DM, Kronbach DW, Kunze M, Gibbs RS. Risk factors for cesarean delivery at presentation of nulliparous patients in labor. Obstet Gynecol. 2003;102:1352-7.

Brennan DJ, Robson MS. Nulliparous term singleton vertex cesarean delivery rates. Am J Obstet Gynecol 2009:200.

Florica M, Stephansson O, Nordstrom L. Indications associated with increased cesarean section rates in a Swedish hospital. Int J Gynaecol Obstet. 2006;92:181-5.

Treacy A, Robson M, O’Herlihy C. Dystocia increases with advancing maternal age. Am J Obstet Gynecol. 2006;195:760-3.