Use of Robson Ten Group Classification to Analyse the Cesarean Section Rate and Formulate Strategies to Optimise the Cesarean Section Rate in a Tertiary Care Institute

BACKGROUND: The increasing rate of cesarean section is a matter of international public health concern as it increases the cesarean section related maternal morbidity. WHO states that the rate should not be more than 15% and rates above 15% are not associated with additional reduction in maternal and neonatal mortality and morbidity. Hence arose the need of standardization of classification of cesarean section through Robson criteria within the healthcare facilities as proposed by MS Robson in the year 2001. According to WHO, Robson classification will aid in optimisation of the cesarean section use, assessment of the strategies aimed to decrease the cesarean section rate and thus improve the clinical practices and quality of care in various health care facilities. This classification system categorizes women into 10 mutually exclusive groups, considering the following criteria: obstetric history (parity and previous Caesarean section), onset of labour (spontaneous, induced, or Caesarean section before onset of labour), fetal presentation or lie (cephalic, breech, or transverse), number of fetuses, and gestational age (preterm or term). AIMS AND OBJECTIVES: To calculate the cesarean section rate in a tertiary care institute. Classify the study population into ten groups according to Robson Ten group classification and to identify which among these groups have the highest cesarean section rate. Formulate strategies to optimize the cesarean section rate. MATERIALS AND METHODS: This is a cross sectional study conducted for a period of 6 months from January 2020-June 2020 at Tirunelveli Medical College and Hospital, a tertiary care institute in Tamil Nadu. All relevant information which would help to classify women according to Robson Ten Group Classification are entered in a excel sheet and results calculated at the end of 6 months.Percentages calculated for the overall rate and representation of each group to overall cesarean section rate. RESULTS: The cesarean section rate in our institute was 40.8 % . Group 5 made the highest contribution to the overall cesarean section rate which was 50.3 % . Followed by Group 2, Group 1 which made 17.4 % and 14 % respectively. Group 4 had 4.2 % , group 3 (3.3%) and group 8 had 2.6 %. All the other groups made a contribution of less than 2% to the overall rate. CONCLUSION: The Robson Ten Group Classification is found to be a useful tool for identifying the obstetric groups escalating the overall cesarean section rates. Group 5 has more cesarean sections in our study and hence efforts to be made to allow VBAC in selected patients with previous cesarean sections with careful monitoring of both fetus and the mother. This classification of cesarean section provides critical assessment of care at delivery and to change practices if used on a continuous basis. Reducing primary cesarean section rates is a key to reduce overall cesarean section rate and the main indication for primary cesarean include CPD ,fetal distress ,non progress of labour and failed induction .The most important thing is to individualize each case and as long as the fetal and maternal condition remains reassuring, induction of labour need not be done electively, especially in a tertiary care institute unless necessity arises. Robson Classification remains an effective tool for the comparison of CS rates over time and also between the institutions globally. Overall cesarean section rate may be reduced as Robson identifies exact areas which needs modifications