Analysis Of Caesarean Sections Based On Robson Classification At A Tertiary Hospital In Ghana: A Cross-Sectional Pre- And Post-Intervention Study

Abstract

Background: Globally, caesarean section (CS) rates are rising progressively in low- and middle-income countries (LMICs) similar to high-income countries creating huge clinical and public health concerns. The WHO recommends the use of Robson classification
system as a global standard in an attempt to understand the determinants of the increasing caesarean births.
Objective: To determine baseline analysis of CS using Robson classification and to identify the trends and determinants of the rising CS rate.
Methods: A cross sectional study was conducted with a pre-intervention (prior to implementation of Robson caesarean classification) and post-intervention (after implementation) phases at a tertiary maternity unit in Ghana
Results: The study included 20270 deliveries comprising 9890 (48.8%) and 10380(51.2%) in the years 2012 and 2013 respectively with mean (±SD) maternal age of 28.6±5.8 years. Caesarean birth occurred in 8121 (40.1%). Caesarean rate was highest and lowest among Robson group 9 and 3 in both the preintervention (92.5% and 8.4%) and post-intervention (90.9% and 12.0%) phases respectively. Robson groups 5 and 9 had the highest (32.0%) and lowest (3.2%) relative contributions to the burden of CS in the preintervention
period respectively. There were mixed findings regarding the patterns of relative contribution of the Robson groups to the burden of CS with an increase in groups 1,3,6,7 and 10, and reduction in groups 2,4,5,8 and 9 in the post-intervention year. There was statistically significant increase in the CS rate in Robson groups 1 (17.2% to 26.5%; OR=1.735, 95%CI 1.482-2.031), group 3 (8.4% to 12.0%; OR=1.478,
95%CI 1.237-1.768) and group 10 (33.8% to 38.7%; OR=1.236, 95%CI 1.056-1.449) in the post intervention phase.
Conclusion: Implementation of Robson classification into the maternity care resulted in identification of characteristics of women associated with caesarean birth: nulliparous or multiparous women with spontaneous labour and no uterine scar (group 1 and 3)
and preterm gestation including previous uterine scar (group 10). We recommend further research into the clinical integration of Robson’s caesarean classification with special focus on predicting maternal and perinatal outcomes.