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Use of the Robson Classification System to Assess Cesarean Delivery Rate in a Tertiary Hospital in the Basque Country

Published:August 07, 2020DOI:https://doi.org/10.1016/j.jogc.2020.06.030

      ABSTRACT

      Objectives

      To assess the rate of cesarean delivery at Basurto University Hospital (Bilbao, Spain) between 2015 and 2017 and to determine the cause of an increase in this rate during 2017.

      Methods

      We retrospectively reviewed 6975 deliveries between 2015 and 2017, classifying women using the Robson classification. We analyzed extended perinatal mortality and perinatal outcomes during the study period and performed a comparative analysis of cesarean deliveries by year and Robson group. Comparisons were made with analysis of variance and χ2 or Fisher's exact tests.

      Results

      During the study period, 928 cesarean deliveries (13.3%) were performed. Extended perinatal mortality in this period was 7.0%. We detected an increase in the rate of cesarean delivery in 2017 in Group 1 women (P = 0.0224), with significant differences in the homogeneity of the distribution of cesarean deliveries performed for fetal distress between years in this group (P = 0.0093). Auditing the cases of cesareans performed for fetal distress in Group 1 in 2017, we found that the indication was appropriate in all cases, but in 39.4%, the management of uterine contractions during labour was considered suboptimal.

      Conclusion

      Classifying cesarean deliveries using the Robson classification allows us to compare cesarean rates in different years and analyze any increases in these rates. Increases are sometimes attributed to changes in the obstetric population, but when investigated may be found to be related to potentially correctable problems. It is not necessary to have a high rate of cesarean delivery to warrant internal audit.

      RÉSUMÉ

      Objectifs

      Évaluer le taux de césariennes à l'hôpital universitaire de Basurto (Bilbao, Espagne) pour la période de 2015 à 2017, et déterminer la cause de l'augmentation de ce taux en 2017.

      Méthodologie

      Nous avons rétrospectivement évalué 6 975 accouchements pour la période de 2015 à 2017 en catégorisant les femmes au moyen de la classification de Robson. Nous avons analysé le taux de mortalité périnatale étendue et les issues périnatales pour la période à l’étude, puis nous avons effectué une analyse comparative des césariennes d'après l'année de l'accouchement et le groupe de classification de Robson. Les comparaisons ont été effectuées au moyen de l'analyse de la variance et le test du χ2 ou le test exact de Fisher.

      Résultats

      Pendant la période à l’étude, 928 césariennes (13,3 %) ont été réalisées. Le taux de mortalité périnatale étendue pour cette période était de 7,0 ‰. Nous avons observé une augmentation du taux de césariennes en 2017 chez les femmes du groupe 1 (P = 0,0224) et des différences significatives quant à l'homogénéité de la distribution des césariennes effectuées pour cause de souffrance fœtale entre les années dans ce groupe (P = 0,0093). La vérification des cas de césariennes effectuées pour cause de souffrance fœtale dans le groupe 1 en 2017 nous a permis de constater que l'indication était appropriée dans tous les cas, mais aussi que dans 39,4 % des cas, la prise en charge des contractions utérines pendant le travail était considérée comme sous-optimale.

      Conclusion

      La classification des césariennes à l'aide de la classification de Robson nous permet de comparer les taux de césariennes au cours de différentes années et d'en analyser les augmentations, le cas échéant. Les augmentations sont parfois attribuées à des changements dans la population obstétricale, mais après une analyse approfondie, il est possible de découvrir qu'elles sont plutôt liées à des problèmes pouvant être corrigés. Il n'est pas nécessaire d'avoir un taux de césariennes élevé pour justifier une vérification interne.

      Keywords

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