Evaluation of Caesarean Section Rates at Sylhet MAG Osmani Medical College Hospital Using the Robson Ten Group Classification System
Abstract
Background: The rising rates of Cesarean Section (CS) globally, and particularly in Bangladesh, have sparked concerns about the overuse of this surgical intervention, which may lead to adverse maternal and neonatal outcomes. The World Health Organization (WHO) recommends a population-based CS rate of 10-15%; however, the rates in many regions far exceed this threshold.
Objectives: The aim of the study was to evaluate the CS rates at Sylhet MAG Osmani Medical College Hospital (SOMCH) using the Robson Ten Group Classification System (TGCS), to identify the key factors contributing to the high prevalence of CS, and to provide evidence-based recommendations for reducing unnecessary procedures.
Methods: This cross-sectional observational study was conducted at SOMCH during July 2022 to June 2023. All pregnant women admitted for delivery at ≥28 weeks of gestation were included and categorized into ten groups according to the TGCS based on specific obstetric characteristics. Data were collected using a structured questionnaire and extracted from medical records. Descriptive statistics were used to analyze the distribution of women across the Robson groups, group-specific CS rates, and the contribution of each group to the overall CS rate. Statistical analyses of the results were be obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-24).
Results: The overall CS rates were reported at Sylhet MAG Osmani Medical College Hospital (SOMCH), 57.43% with 2849 CS cases among 4960 admitted women. The group size, CS rate, and absolute group contribution to overall CS were 24.29%, 36.29%, and 8.81%, respectively in group 1. Another important group includes nulliparous women with single cephalic pregnancies at 37 weeks or more who had induced labor or a CS before labor, which accounted for 11.85% of deliveries with a high CS rate of 72.61% and contributed 8.60% to the overall CS rate. Similarly, multiparous women without a previous CS who received induction or a CS before to labor (Group 4) have a CS rate of 75.83%, accounting for 5.06%.
Conclusion: The study highlights the need for targeted interventions to reduce unnecessary CS procedures at SOMCH. Key recommendations include promoting Vaginal Birth After Cesarean (VBAC), optimizing labor induction practices, and standardizing clinical decision-making processes. Continuous monitoring and evaluation using the TGCS will be essential to ensure that CS is used judiciously, ultimately improving maternal and neonatal health outcomes.
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References
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