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. 2022 Mar 13;14(3):e23133.
doi: 10.7759/cureus.23133. eCollection 2022 Mar.

Cesarean Audit Using Robson Classification at a Tertiary Care Center in Bihar: A Retrospective Study

Pammy Pravina  1 , Ranjana Ranjana  1 , Neeru Goel  1
Affiliations

Cesarean Audit Using Robson Classification at a Tertiary Care Center in Bihar: A Retrospective Study

Pammy Pravina et al. Cureus. .

Abstract

Background Since 1985, the international healthcare community has considered the ideal rate for cesarean section (CS) to be between 10% and 15%.However, CS has been increasing both in developed and developing countries. The aim of the present study was to audit CS using Robson's Ten Group Classification System (TGCS). Methodology This retrospective, hospital record-based study was conducted over a period of three years from April 1, 2016, to March 31, 2019, in the Department of Obstetrics and Gynecology at Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. Data of patients who delivered by CS during this period were recorded and categorized in the 10 groups of TGCS. The size of each group, CS rate, and contribution of each group toward overall CS were calculated. Indications of CS in each group were analyzed, and strategies were planned to optimize the use of CS. The Chi-square test was used to analyse the statistical significance of the differences in the number of CS between the different Robson's groups. Results The total number of deliveries was 2,128 during the study period, of which CS was performed in 812 deliveries, with a CS rate of 38.16% in our institute. Robson's group 5 (34.97%) was the major contributor to the overall CS rate, followed by group 2 (26.35%), group 1 (15.51%), and group 10 (7.14%). The incidence of primary CS (61.82%) was more than repeat CS (38.17%). Previous CS, fetal distress, failed induction, arrest of labor, and malpresentation were the main indications for CS. Conclusions Robson's TGCS serves as an important tool for auditing CS. Indications of CS among major contributors and primary group should be analyzed regularly and uniform and standard protocols should be used. Standardization of indications for CS, regular audits, and definite protocols will help in reducing the CS rate in our hospital.

Keywords: audit; cesarean section; cesarean section rate; indications of cesarean section; robson’s ten group classification system.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flowchart of deliveries in our study population.
Figure 2
Figure 2. Incidence of primary versus repeat cesarean section.
Figure 3
Figure 3. Indications of CS among other major/minor contributor groups of TGCS.
CS: cesarean section; CPD: cephalopelvic disproportion; APH: antepartum hemorrhage; TGCS: Robson’s Ten Group Classification System
Figure 4
Figure 4. Studies showing the overall CS rate and the contribution of different TGCS groups to the overall CS rate.
CS: cesarean section; TGCS: Robson’s Ten Group Classification System
Figure 5
Figure 5. CS rates in different countries as per the latest survey (United Nations geographical grouping, 2018).
CS: cesarean section
See this image and copyright information in PMC

References

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