Improving Safe Vaginal Deliveries for Delivering Mothers by Implementing an Intervention Package of 11 Evidence-based Practices and Robson Classification at a Semi-urban Hospital in Dhaka, Bangladesh (ISVD)

Improving Safe Vaginal Deliveries Using Evidence-based Practices at a Semi-urban Hospital in Dhaka, Bangladesh

The objective of this study was to assess whether a package of 11 evidence-based maternity practices, combined with routine monitoring and Robson Classification, could reduce C-section rates in a semi-urban hospital in Dhaka, Bangladesh.

Our intervention targeted the key drivers of unnecessary caesarean section at CWCH: weak labour monitoring, low use of evidence-based induction/vaginal birth after caesarean (VBAC) criteria, limited consultant oversight of C-section indications, and insufficient antenatal counselling.

Study Overview

• Status: Completed
• Conditions: Caesarean Section
• Intervention / Treatment: Other: Package of 11 evidence-based maternity practices combined with Robson TGCS Classification

• Study Type: Interventional
• Enrollment (Actual): 2475
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Bangladesh
  • Dhaka Division
    • Dhaka, Dhaka Division, Bangladesh, 1349
      • Ashulia Women and Children Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

- Admitted into the maternity and labour ward of AWCH for delivery.

Exclusion Criteria:

• Unable to provide consent
• Age is less than 18 years
• Refused to participate in the study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Sequential Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Pre-intervention Baseline Phase; Participants recruited before implementation of the intervention to compare against participants that will receive the intervention
Active Comparator: Post-intervention Endline Phase; Participants recruited after implementation of the intervention to compare against participants that did not receive the intervention	Other: Package of 11 evidence-based maternity practices combined with Robson TGCS Classification; The intervention package comprised 11 evidence-based maternity practices designed to reduce unnecessary C-sections and promote safe vaginal deliveries: ANC counselling for expecting mothers.; Waiting up to 41 weeks of gestation for spontaneous onset of labour.; Risk screening for NVD and induction of labour at term.; Assessment of Bishop Score on admission.; Supportive care during labour and delivery.; Continuous monitoring with CTG.; Use of partograph; Induction or augmentation of labour as indicated, using prostaglandin or oxytocin for induction, based on Bishop Score.; Consultant review of CS indications during ward rounds.; Vaginal birth after caesarean (VBAC) for selected cases with appropriate monitoring.; Immediate care of the newborn. Additionally, all deliveries were classified using the Robson Ten Group Classification System.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Caesarean section rate	Proportion of caesarean sections among total deliveries	70 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Absolute and non-absolute indications for caesarean sections	Proportion of absolute and non-absolute indications among all deliveries by caesarean sections. Absolute indications are situations where vaginal delivery is not possible or poses a highly significant risk to the mother or baby. Non-absolute indications are situations where a caesarean section might be considered based on the potential risks and benefits for both the mother and the baby, and vaginal delivery may still be an option. Absolute indications include: obstructed labour, grade 3 or 4 placenta praevia, impending uterine rupture, and malpresentation. Non-absolute indications include: failure to progress in labour, prolonged labour, failed induction, previous caesarean delivery, antepartum haemorrhage, preeclampsia/eclampsia, psychological indication, maternal request, precious (valuable) pregnancy, foetal compromise, and breech presentation.	70 weeks
Robson classification for all deliveries	Robson classification for all deliveries. The Robson classification is a system for classifying pregnant women who undergo childbirth. There are a total of 12 mutually-exclusive groups and subgroups to which every delivering mother is assigned to. These are: 1 Nulliparous, single cephalic, >=37 weeks, spontaneous labour; 2a Nulliparous, single cephalic, >=37 weeks, induced labour; 2b Nulliparous, single cephalic, >=37 weeks, CS before labour; 3 Multiparous (no previous CS), single cephalic, >=37 weeks, spontaneous labour; 4a Multiparous (no previous CS), single cephalic, >=37 weeks, induced labour; 4b Multiparous (no previous CS), single cephalic, >=37 weeks, CS before labour; 5 Multiparous, previous CS, single cephalic, >=37 weeks; 6 Nulliparous with single breech; 7 Multiparous with single breech (including previous CS); 8 All multiple pregnancies (including previous CS); 9 All abnormal lies (including previous CS); 10 All single cephalic, <37 weeks (including previous CS).	70 weeks
Absolute CS rate by Robson Classification	Absolute proportion of caesarean sections among all Robson groups. Absolute rate is calculated by: number of caesarean section in the Robson group/total number of deliveries in the hospital * 100	70 weeks
Relative CS rate by Robson Classification	Relative proportion of caesarean sections among all Robson groups. Relative rate is calculated by: number of caesarean sections in the Robson group/total number of caesarean sections in the hospital * 100	70 weeks

Collaborators and Investigators

• Sponsor: Ashulia Women and Children Hospital

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2017
• Primary Completion (Actual): February 10, 2019
• Study Completion (Actual): August 18, 2019

Study Registration Dates

• First Submitted: March 3, 2026
• First Submitted That Met QC Criteria: March 6, 2026
• First Posted (Actual): March 10, 2026

Study Record Updates

• Last Update Posted (Actual): March 12, 2026
• Last Update Submitted That Met QC Criteria: March 10, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: caesarean section; Bangladesh; maternal health; Robson classification; VBAC; reproduction; normal vaginal delivery
• Other Study ID Numbers: CWCH/ERC/2017/010

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No