Cesarean section rate in siriraj hospital according to the robson classification

Abstract

© 2020 Royal Thai Journal of Obstetrics and Gynaecology. Objectives: To determine the cesarean section (CS) rate in Siriraj Hospital according to Robson classification. Materials and Methods: In this cross-sectional study, all pregnant women who delivered in Siriraj Hospital during January to August, 2017 were included. Data were retrieved from medical records, including baseline, obstetric, and delivery information. Pregnant women were categorized into ten-group according to Robson classification. Overall and group-specific CS rate and contribution of CS were reported. Results: A total of 4,998 pregnant women were included. Mean maternal age was 29.9 years, 50.7% were nulliparous, and 17.9% had previous CS. Of all women, 2,442 were delivered by CS (48.86%). Majority of cases were in group 1 (nulliparous with a single cephalic term pregnancy in spontaneous labor, 31.21%), followed by group 3 (multiparous with a single cephalic term pregnancy in spontaneous labor, 25.21%) and group 5 (multiparous with a previous uterine scar with a single cephalic term pregnancy, 14.17%), respectively. Major contribution of CS were from group 5 (28.91%), group 1 (23.71%), and group 2 (17.65%). Group-specific CS rates in group 1, 2, and 4 (multiparous with a single cephalic term pregnancy without spontaneous labor) were 37.12%, 84.02%, 58.53%, respectively. Further analysis showed that 68.4% of nulliparous and 55% of multiparous women without spontaneous labor (subgroup 2b and 4b) had pre-labor CS and most indications could be unnecessary. CS rate in nulliparous and multiparous women with labor induction (group 2a and 4a) were 49.38% and 7.41%, respectively, and labor was induced before 40 weeks in majority of the women, possibly without appropriate indications. Conclusion: Overall CS rate in Siriraj Hospital was 48.86%. Group 1 and 2 contributed to one-third of the procedures that appropriate interventions should be developed to reduce CS rate.