Caesarean section in Palestine using the Robson Ten Group Classification System: a population-based birth cohort study

Mohammed Walid Zimmo, Katariina Laine, Sahar Hassan, Bettina Bottcher, Erik Fosse, Hadil Ali-Masri, Kaled Zimmo, Ragnhild Sørum Falk, Marit Lieng, Åse Vikanes, Mohammed Walid Zimmo, Katariina Laine, Sahar Hassan, Bettina Bottcher, Erik Fosse, Hadil Ali-Masri, Kaled Zimmo, Ragnhild Sørum Falk, Marit Lieng, Åse Vikanes

Abstract

Objective: To analyse the current situation of caesarean section in Palestine using the Robson Ten Group Classification System (TGCS).

Design: A population-based birth cohort study.

Setting: Obstetrical departments in three governmental hospitals in Gaza.

Participants: All women (18 908) who gave birth between 1 January 2016 and 30 April 2017.

Methods: The contributions of each group to the study population and to the overall rate of caesarean section were calculated, as well as the rate of caesarean section in each TGCS group. Differences in proportions between study hospitals were assessed by χ2 test.

Main outcome measures: The main outcome was the contributions of each group to the overall caesarean section rate.

Results: The overall rate of caesarean section was 22.9% (4337 of 18 908), ranging from 20.6% in hospital 1 to 24.6% in hospital 3. The largest contributors to the overall caesarean section rate were multiparous women with single cephalic full-term pregnancy who had undergone at least one caesarean section (group 5, 42.6%), women with multiple pregnancies (group 8, 11.6%) and those with single cephalic preterm labour (group 10, 8.1%). Statistically significant differences in caesarean section rates between the study hospitals were observed in group 1 (nulliparous women with single cephalic full-term pregnancy and spontaneous labour), group 4 (multiparous with single cephalic full-term pregnancy with induced labour or prelabour caesarean section), group 5 (multiparous with single cephalic full-term pregnancy with previous caesarean section) and in group 7 (multiparous with breech presentation).

Conclusion: Women in groups 5, 8 and 10 were the largest contributors to the overall caesarean section rate in the study hospitals. Efforts to reduce the differences in obstetrical care between hospitals need to be directed towards increasing the proportion of vaginal births after caesarean section and by reducing primary caesarean section in multiple pregnancies and preterm labour.

Keywords: caesarean section; gaza; maternal medicine; palestine; prenatal diagnosis; robson ten group classification system.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow chart of the study population, multicentre study from Palestine (from 1 January 2016 to 30 April 2017).
Figure 2
Figure 2
Contribution of each group in the Robson Ten Group Classification System to the overall caesarean section prevalence in the study hospitals (n=4337).

References

    1. Betrán AP, Ye J, Moller AB, et al. . The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014. PLoS One 2016;11:e0148343 10.1371/journal.pone.0148343
    1. Bragg F, Cromwell DA, Edozien LC, et al. . Variation in rates of caesarean section among English NHS trusts after accounting for maternal and clinical risk: cross sectional study. BMJ 2010;341:c5065 10.1136/bmj.c5065
    1. Zimmo M, Laine K, Hassan S, et al. . Differences in rates and odds for emergency caesarean section in six Palestinian hospitals: a population-based birth cohort study. BMJ Open 2018;8:e019509 10.1136/bmjopen-2017-019509
    1. Organization WH. Appropriate technology for birth. Lancet 1985;2:436–7.
    1. Robson MS. Classification of caesarean sections. Fetal Matern Med Rev 2001;12:23–39. 10.1017/S0965539501000122
    1. Betran AP, Torloni MR, Zhang JJ, et al. . WHO Statement on caesarean section rates. BJOG 2016;123:667–70. 10.1111/1471-0528.13526
    1. Chong C, Su LL, Biswas A. Changing trends of cesarean section births by the Robson Ten Group Classification in a tertiary teaching hospital. Acta Obstet Gynecol Scand 2012;91:1422–7. 10.1111/j.1600-0412.2012.01529.x
    1. Ciriello E, Locatelli A, Incerti M, et al. . Comparative analysis of cesarean delivery rates over a 10-year period in a single Institution using 10-class classification. J Matern Fetal Neonatal Med 2012;25:2717–20. 10.3109/14767058.2012.712567
    1. Ministry of Health. : Ramallah P, Health status, palestine 2015163: State of Palestine, 2016:50–3.
    1. United Nations Population Fund, UNFPA. Palestine 2030 demographic change: opportunities for development, December 2016. 55: United Nations Population Fund, UNFPA:86.
    1. Hassan S, Vikanes A, Laine K, et al. . Building a research registry for studying birth complications and outcomes in six Palestinian governmental hospitals. BMC Pregnancy Childbirth 2017;17:112 10.1186/s12884-017-1296-6
    1. Robson M. The Ten Group Classification System (TGCS) - a common starting point for more detailed analysis. BJOG 2015;122:701–01. 10.1111/1471-0528.13267
    1. Barčaitė E, Kemeklienė G, Railaitė DR, et al. . Cesarean section rates in lithuania using robson ten group classification system. Medicina 2015;51:280–5. 10.1016/j.medici.2015.09.001
    1. Tura AK, Pijpers O, de Man M, et al. . Analysis of caesarean sections using Robson 10-group classification system in a university hospital in eastern Ethiopia: a cross-sectional study. BMJ Open 2018;8:e020520 10.1136/bmjopen-2017-020520
    1. Lafitte AS, Dolley P, Le Coutour X, et al. . Rate of caesarean sections according to the Robson classification: Analysis in a French perinatal network - Interest and limitations of the French medico-administrative data (PMSI). J Gynecol Obstet Hum Reprod 2018;47:39–44. 10.1016/j.jogoh.2017.11.012
    1. Roberge S, Dubé E, Blouin S, et al. . Reporting caesarean delivery in quebec using the robson classification system. J Obstet Gynaecol Can 2017;39:152–6. 10.1016/j.jogc.2016.10.010
    1. Kacerauskiene J, Bartuseviciene E, Railaite DR, et al. . Implementation of the Robson classification in clinical practice:lithuania’s experience. BMC Pregnancy Childbirth 2017;17:432 10.1186/s12884-017-1625-9
    1. Hehir MP, Ananth CV, Siddiq Z, et al. . Cesarean delivery in the United States 2005 through 2014: a population-based analysis using the Robson 10-Group Classification System. Am J Obstet Gynecol. In Press 2018;219:105.e1–105.e11. 10.1016/j.ajog.2018.04.012
    1. World Health Organization. Robson classification: implementation manual. Geneva: World Health Organization, 2017.
    1. Brennan DJ, Robson MS, Murphy M, et al. . Comparative analysis of international cesarean delivery rates using 10-group classification identifies significant variation in spontaneous labor. Am J Obstet Gynecol 2009;201:308.e1–308.e8. 10.1016/j.ajog.2009.06.021
    1. Nakamura-Pereira M, do Carmo Leal M, Esteves-Pereira AP, et al. . Use of Robson classification to assess cesarean section rate in Brazil: the role of source of payment for childbirth. Reprod Health 2016;13:128 10.1186/s12978-016-0228-7
    1. Kazmi T, Saiseema S, Khan S. Analysis of Cesarean Section Rate - According to Robson’s 10-group Classification. Oman Med J 2012;27:415–7. 10.5001/omj.2012.102
    1. Grobman WA, Lai Y, Landon MB, et al. . The change in the VBAC rate: an epidemiologic analysis. Paediatr Perinat Epidemiol 2011;25:37.
    1. Russillo B, Sewitch MJ, Cardinal L, et al. . Comparing rates of trial of labour attempts, VBAC success, and fetal and maternal complications among family physicians and obstetricians. J Obstet Gynaecol Can 2008;30:123–8. 10.1016/S1701-2163(16)32735-9
    1. Maneschi F, Algieri M, Perrone S, et al. . Cesarean 10-group classification: a tool for clinical management of the delivery ward. Minerva Ginecol 2015;67:389–95.
    1. Perinatal Services BC. Examining cesarean delivery rates in British Columbia using the Robson ten classification. Part 1: understanding the ten groups. 1 Vancouver, BC, 2011.
    1. Le Ray C, Prunet C, Deneux-Tharaux C, et al. . [Robson classification: a tool for assessment of caesarean practices in France]. J Gynecol Obstet Biol Reprod 2015;44:605–13.
    1. Sinnott SJ, Brick A, Layte R, et al. . National variation in caesarean section rates: a cross sectional study in Ireland. PLoS One 2016;11:e0156172 10.1371/journal.pone.0156172
    1. Robson M, Hartigan L, Murphy M. Methods of achieving and maintaining an appropriate caesarean section rate. Best Pract Res Clin Obstet Gynaecol 2013;27:297–308. 10.1016/j.bpobgyn.2012.09.004
    1. Betrán AP, Gulmezoglu AM, Robson M, et al. . WHO global survey on maternal and perinatal health in Latin America: classifying caesarean sections. Reprod Health 2009;6:18 10.1186/1742-4755-6-18

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren