Robson's Ten Group Classification System to Evaluate Cesarean Section Rates in Honduras: The Relevance of Labor Induction

Paz, Lester David Castro; Banegas, Rigoberto Castro; Luz, Adriana Gomes; Costa, Maria Laura

doi:10.1055/s-0042-1753547

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Article • Rev Bras Ginecol Obstet 44 (9) • 2022 • https://doi.org/10.1055/s-0042-1753547 copy

Robson's Ten Group Classification System to Evaluate Cesarean Section Rates in Honduras: The Relevance of Labor Induction

Sistema de classificação de dez grupos de Robson para avaliar taxas de parto cesárea: A importância da indução do trabalho de parto

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To use the Robson Ten Group Classification (RTGC) to analyze cesarean section (CS) rates in a Honduran maternity hospital, with focus in groups that consider induction of labor.

Methods

Cross-sectional study. Women admitted for childbirth (August 2017 to October 2018) were classified according to the RTGC. The CS rate for each group and the contribution to the overall CS rate was calculated, with further analyses of the induction of labor among term primiparous (group 2a), term multiparous (group 4a), and cases with one previous CS (group 5.1).

Results

A total of 4,356 women were considered, with an overall CS rate of 26.1%. Group 3 was the largest group, with 38.6% (1,682/4,356) of the cases, followed by Group 1, with 30.8% (1,342/4,356), and Group 5, with 10.3% (450/4,356). Considering the contribution to overall CS rates per group, Group 5 contributed with 30.4% (345/1,136) of the CSs and within this group, 286/345 (82.9%) had 1 previous CS, with a CS rate > 70%. Groups 1 and 3, with 26.6% (291/1,136) and 13.5% (153/1,136), respectively, were the second and third larger contributors to the CS rate. Groups 2a and 4a had high induction success, with low CS rates (18.4 and 16.9%, respectively).

Conclusion

The RTGC is a useful tool to assess CS rates in different healthcare facilities. Groups 5, 1, and 3 were the main contributors to the CS rate, and groups 2 and 4 showed the impact and importance of induction of labor. These findings may support future interventions to reduce unnecessary CS, especially among primiparous and in women with previous CS.

Keywords
cesarean section; labor; induced; childbirth

GROUP	GROUP DESCRIPTION	RELATIVE SIZE OF THE GROUP % (n)	CS RATE WITHIN GROUP % (n)	ABSOLUTE GROUP CONTRIBUTION TO OVERALL CS RATE % (n)	RELATIVE GROUP CONTRIBUTION TO OVERALL CS RATE % (n)
1	Nulliparous, single, cephalic, ≥ 37 weeks, spontaneous onset	30.8% (1,342/4,356)	21.7% (291/1,342)	6.7% (291/4,356)	26.62% (291/1,136)
2	Nulliparous, single, cephalic, ≥ 37 weeks, induced onset or elective CS	6.2% (268/4,356)	38.8% (104/268)	2.4% (104/4,356)	9.15% (104/1,136)
3	Multiparous, without cesarean delivery scar, single, cephalic, ≥ 37 weeks, spontaneous onset.	38.6% (1,682/4,356)	9.1% (153/1,682)	3.5% (153/4,356)	13.47% (153/1,136)
4	Multiparous, without a cesarean delivery scar, single, cephalic, ≥ 37 weeks, induced onset, or elective CS	5.0% (216/4,356)	25.0% (54/216)	1.2% (54/4,356)	4.75% (54/1,136)
5	All multiparous women with at least 1 previous CS, single, cephalic, ≥ 37 weeks.	10.3% (450/4,356)	76.7% (345/450)	7.9% (345/4,356)	30.37% (345/1,136)
6	All nulliparous, single, breech	0.9% (40/4,356)	87.5% (35/40)	0.8% (35/4,356)	3.08% (35/1,136)
7	All multiparous, single, breech, includes women with a previous CS	1.4% (61/4,356)	78.7% (48/61)	1.1% (48/4,356)	4.23% (48/1,136)
8	All women with multiple pregnancy, includes women with a previous CS	1.1% (48/4,356)	64.6% (31/48)	0.7% (31/4,356)	2.73% (31/1,136)
9	All women, single, in transverse or oblique, includes women with a previous CS	0.7% (31/4,356)	100% (31/31)	0.7% (31/4,356)	2.73% (31/1,136)
10	All women, single, cephalic, ≤ 36 weeks, includes women with a previous CS	5.0% (218/4,356)	20.2% (44/218)	1.1% (44/4,356)	3.87% (44/1,136)
TOTAL			26.1% (1,136/4,356)		100% (1,136)

GROUP	DESCRIPTION	TOTAL NUMBER OF CASES PER GROUP	SUBGROUP n (%)	SUBGROUP DEFINITION	CS RATE WITHIN THE SUBGROUP % (n)
2	Nulliparous women with single cephalic pregnancy ≥ 37 weeks, who underwent induction of labor or CS before the start of labor	268	2a 201 (75%)	Induced labor	18.40% (37/201)
2		268	2b 67 (25%)	Scheduled CS (prior to labor)	100.00% (67/67)
4	Multiparous women without previous uterine scar, with a simple cephalic pregnancy ≥ 37 weeks, who underwent induction of labor or CS before the start of labor	216	4a 195 (90.3%)	Induced labor	16.92% (33/195)
4		216	4b 21 (9.7%)	Scheduled CS (prior to labor)	100.00% (21/21)
5	All multiparous women with a history of at least 1 previous uterine scar with pregnancy ≥ 37 weeks, cephalic	450	5.1 391 (86.9%)	One previous CS	73.15% (286/391)
5		450	5.2 59 (13.1%)	≥ 2 previous CSs	100.00% (59/59)

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[1] Address for correspondence Maria Laura Costa, MD, PhD, Associate professor of the Obstetrics Department, Universidade Estadual de Campinas, 101, Alexander Fleming St, Campinas, SP, Brazil (e-mail: mlaura@unicamp.br).