Can the Robson 10 Group Classification System help identify which groups of women are driving the high caesarean section rate in major private hospitals in eastern Ethiopia? A cross-sectional study

Shegaw Geze, Abera Kenay Tura*, Sagni Girma Fage, Thomas Van Den Akker

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Objective The rates of caesarean section (CS) in Ethiopian private hospitals are high compared with those in public facilities, and there are limited descriptions of groups of women contributing to these high rates. The objective of this study was to describe the groups contributing to increased CS rates using the Robson classification in two major private hospitals in eastern Ethiopia. Design Cross-sectional study. Setting Two major private hospitals in eastern Ethiopia. Participants All women who gave birth from 9 January 2019 to 8 January 2020 in two major private hospitals in eastern Ethiopia. Primary and secondary outcome measures The primary outcome was the Robson 10 Group Classification System. The secondary outcome was indication for CS as recorded in the medical files. Results Of 1203 births in both hospitals combined during the study period, 415 (34.5%) were by CS. Women with a uterine scar due to previous CS (group 5), single cephalic term multiparous women in spontaneous labour (group 3) and single cephalic term nulliparous women in spontaneous labour (group 1) were the leading groups contributing 33%, 27.5% and 17.1%, respectively. The leading documented indications were fetal compromise (29.4%), previous CS (27.2%) and obstructed labour (12.3%). Conclusion More than three-fourths of CS were performed among Robson groups 5, 3 and 1, indicating inadequate trial of labour after CS or management of labour among relatively low-risk groups (3 and 1). Improving management of spontaneous labour and strengthening clinical practice around safely providing the option of vaginal birth after CS practice are strategies required to reduce the high CS rates in these private facilities.

Original languageEnglish
Article numbere047206
JournalBMJ Open
Volume11
Issue number8
DOIs
Publication statusPublished - 26 Aug 2021

Bibliographical note

Funding Information:
Contributors AKT conceived the study and wrote the original draft of the manuscript, which was subsequently reviewed by SG, SGF and TvdA. SG was involved in proposal development and collected data under the supervision and mentorship of AKT. Analysis was done by AKT. SG, SGF and TvdA reviewed the manuscript for intellectual content and participated in the revision. All authors contributed to the writing and reviewed the article and approved the final version of the manuscript to be published. Funding SG received a grant from Haramaya University for his MSc study. Disclaimer The funding organisation has no role in the design, execution or decision to publish the study. Competing interests None declared.

Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

Keywords

  • audit
  • epidemiology
  • obstetrics
  • public health

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