Use of Robson’s Ten Group Classification System to Optimize Caesarean Section Rate; An Audit in a Tertiary Care Centre, Rawalpindi, Pakistan.

Abstract

Objective: To implement Robson's Ten Group Classification System (TGCS) to identify the main contributory factors to the cesarean section (CS) rate and subsequently formulate effective recommendations to optimize this rate.

Methodology: A prospective cross-sectional study was conducted from November 2020 to June 2022 at Benazir Bhutto Hospital, Rawalpindi. All women delivering a live or stillborn baby of ≥ 24 weeks’ gestation during the study period were categorized into 10 groups of the TGCS based on specific obstetric parameters. Descriptive statistical analysis was performed to assess the overall CS rate, the size of each group, individual group CS rates, and their contributions to the overall CS rate.

Results: Out of the total deliveries (14,883) during the study period, CS was performed in 6,115 cases, resulting in an overall CS rate of 41.08%. The largest presenting group was Robson's Group 03, while Group 05 (multiparas, scarred uterus, single cephalic term fetus) was the major contributor (45.49%) to the overall CS rate, followed by Group 01 (10.33%), Group 02 (10.20%), and Group 10 (9.95%). The largest contribution by Group 05 can be attributed to the paucity of Vaginal Birth After Caesarean (VBAC), leading to repeat elective CS. Induction of labor (IOL) is another contributing factor.

Conclusion: The Robson’s TGCS is effective tool for auditing CS by high-lighting the major contributory factors to CS rate, gearing strategies to optimize CS rate through regular departmental audits, protocols and justified indications. Key words: Robson’s classification system, caesarean section rate, indications of caesarean section, caesarean section audit.