Publication:

Analysis of caesarean section at the University of Benin Teaching Hospital using Robson 10-group classification system: an observational retrospective study

Background Caesarean section (CS) refers to the delivery of the foetus, placenta, and membranes through an abdominal and uterine incision.  In order to understand the factors responsible for rising CS rate and suggest effective measures to reduce CS rate, it is necessary to have a tool to monitor and compare CS rate in the same setting, over time and between different settings. It has been shown that women-based classification in general and the 10-group classification in particular were best to fulfil current international and local needs. This study aimed to analyse Caesarean sections at the University of Benin Teaching Hospital over one year using the Robson 10 group classification system.

Methods This is an observational retrospective study at the University of Benin Teaching Hospital (UBTH), Benin City, Edo State, Nigeria. All women who gave birth at UBTH from January 1st 2020, to December 31st 2020, were studied. Data were collected using a proforma, chi-square analysis was done, and a p-value less than 0.05 was considered statistically significant.

Results The Caesarean section rate during the study period of this was 45.8%. Using the Robson classification system, the highest group of women that delivered during the period was group 3 (multiparous (excluding previous CS), single cephalic, ≥/37weeks in spontaneous labour), followed by Group 5 (all multiparous with at least 1 previous CS, single cephallic, ≥/37weeks) and Group 4 (multiparous, excluding previous CS), single cephallic, ≥/37weeks, induced or pre labour CS). The highest contributing group to CS rate was Group 5, followed by Group 2 (nulliparous, single cephallic, ≥/37weeks, induced or pre labour CS), Group 10 (all women with a single cephallic pregnancy, <37 weeks, including women with previous CS(s)) and Group 4. Groups 8 (all women with multiple pregnancies, including women with previous CS(s)),10 and 7 (all multiparous women with a singleton breech pregnancy, including women with previous CS(s)) had the highest contribution to stillbirth and babies with 5th minute APGAR less than 7.

Conclusions The study revealed a high CS rate in UBTH, with Robson Groups 5,10 and 2 accounting for a large percent of the CS rate during the study period. Effort should be targeted at reducing primary CS rate by reducing the incidence of failed IOL in nulliparous to the barest minimum, appropriate monitoring of labour to reduce the incidence of positional CPD, increased utilization of alternative to CS section, such as instrumental delivery and external cephalic version when they are indicated. The trend of increasing utilization of CS for indications that is not purely obstetric, such as maternal request, should be discouraged.