Use of Robson Classification to Analyze Contributors to the Caeserean Section Rates and Associated Early Maternal and Peri-natal Outcomes at the Pumwani Maternity Hospital for the Year 2016 (Descriptive Retrospective Cohort Study)

Abstract

Background: There has been growing concern over increasing Caesarean Section (CS) rates due to potential increase in maternal and perinatal risks. Globally, CS rates have increased from 6% in 1990 to 19% in 2014 while this rates was at 7% , 4% and 9% in Africa, East Africa and Kenya respectively as of 2014. In 2011, the World Health Organization (WHO) proposed the ten-step Robson Classification system as a global standard for assessing, monitoring and comparing CS rates within health-care facilities over time, and between facilities. We used the Robson classification to analyze the CS rates in a busy County Maternity Hospital in Kenya and its association with early maternal and perinatal outcomes. Objective: To analyze CS rates and selected early pregnancy outcomes in a busy County Maternity Hospital in Kenya, using the Robson classification. Methodology: Study design: A descriptive one -year retrospective cohort study in which records of 499 women who underwent caesarean section between 1stJanuary 2016 to 31st December 2016 were reviewed. Study Setting: Pumwani Maternity Hospital in Nairobi County in Kenya. Data analysis: All women were categorized into Robson groups. We estimated the relative size, the CS rate and the absolute and relative contributions made by each Robson group to the overall CS rate and the association of each group with selected early maternal and perinatal outcomes. Differences were analyzed through chi-square and the Z-test with a significance level of <0.05. Data were analysed using STATA-version 12. Results: The Robson groups with the highest contribution to the CS rates were low risk women: Group 1(the nulliparous, at term, single gestation, spontaneous labour), Group 5 (all multi-parous women, at least one previous uterine scar, single gestation, cephalic, at term), and Group 3 (multi-parous, no uterine scar, at term, single gestation, cephalic, spontaneous labour) at 36%,

24% and 24% respectively. The early pregnancy outcomes: Apgar scores <7 at 5 minutes, severe postpartum haemorrhage, maternal and neonatal death within 24 hours, were similar across all the 10 Robson groups. Conclusion Robson classification was easily applied and identified low-risk women as the largest contributors to the CS rates at Pumwani Maternity Hospital. Additional studies should evaluate indications for CS and identify strategies for reducing CS in this low-risk obstetric population.