scholarly journals Interinstitutional Variation of Caesarean Delivery Rates According to Indications in Selected Obstetric Populations: A Prospective Multicenter Study

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Gianpaolo Maso ◽  
Monica Piccoli ◽  
Marcella Montico ◽  
Lorenzo Monasta ◽  
Luca Ronfani ◽  
...  
Keyword(s):  
Caesarean Delivery ◽  
Relative Size ◽  
Group Classification ◽  
Prospective Multicenter Study ◽  
Nulliparous Women ◽  
Spontaneous Labour ◽  
Multiparous Women ◽  
Regional Centers ◽  
Spearman’S Correlation ◽  
Failure To Progress

The aim of the study was to identify which groups of women contribute to interinstitutional variation of caesarean delivery (CD) rates and which are the reasons for this variation. In this regard, 15,726 deliveries from 11 regional centers were evaluated using the 10-group classification system. Standardized indications for CD in each group were used. Spearman’s correlation coefficient was used to calculate (1) relationship between institutional CD rates and relative sizes/CD rates in each of the ten groups/centers; (2) correlation between institutional CD rates and indications for CD in each of the ten groups/centers. Overall CD rates correlated with both CD rates in spontaneous and induced labouring nulliparous women with a single cephalic pregnancy at term (P=0.005). Variation of CD rates was also dependent on relative size and CD rates in multiparous women with previous CD, single cephalic pregnancy at term (P<0.001). As for the indications, “cardiotocographic anomalies” and “failure to progress” in the group of nulliparous women in spontaneous labour and “one previous CD” in multiparous women previous CD correlated significantly with institutional CD rates (P=0.021,P=0.005, andP<0.001, resp.). These results supported the conclusion that only selected indications in specific obstetric groups accounted for interinstitutional variation of CD rates.

The dynamics of caesarean section rate in tula region: a 10-year retrospective multicenter study

10.12737/6453 ◽  
2014 ◽  
Vol 8 (1) ◽  
pp. 0-0
Author(s):  
Бадаева ◽  
A. Badaeva
Keyword(s):  
Retrospective Study ◽  
Caesarean Section ◽  
Rate Increase ◽  
Caesarean Section Rate ◽  
Group Classification ◽  
Nulliparous Women ◽  
Multiparous Women ◽  
Year 2000 ◽  
Retrospective Multicenter Study

Objectives. To study the trend of Caesarean section (CS) rate increase in the Tula region. Methods. A multicenter retrospective study of labor and delivery reports of women in Tula region, Russia who had CS procedures between the years 2000 and 2010. Robson’s Ten-Group Classification System (10-group classification) provides a clinically relevant classification of CS rates that provides a useful basis for internation-al comparisons and trend analyses. Results. In Tula region the total number of deliveries increased by 26.6% from the year 2000 as compared to 2010, the CS rate increased from 17.1 to 27.7%. The increase in CS deliveries was mostly attributed to three characteristic groups: multiparous women with uterine cicatrix; primaparous women who had medical conditions for a planned CS and these, who had labor induction; women with a gestational age less than 37 weeks. The largest Robson group was nulliparous women in spontaneous labor. Conclusions. Future efforts to reduce the overall CS rate should be focussed on reducing the primary CS rate.

scholarly journals Discrimination by parity is a prerequisite for assessing induction of labour outcome – observational study

2019 ◽  
Author(s):  
Branko Denona ◽  
Michael Foley ◽  
Rhona Mahony ◽  
Michael Robson
Keyword(s):  
Caesarean Section ◽  
Observational Study ◽  
Group Classification ◽  
Induction Of Labour ◽  
Previous Caesarean Section ◽  
Obstetric Outcome ◽  
Nulliparous Women ◽  
Significant Difference ◽  
Multiparous Women ◽  
Group 3

Abstract Objective: To demonstrate that studies on induction of labour should be analyzed by parity as there is a significant difference in the labour outcome among induced nulliparous and multiparous women Methods: Obstetric outcome, specifically caesarean section rates, among induced term nulliparous and multiparous women without a previous caesarean section were analyzed using the Robson 10 group classification 2 for the year 2016. Results: The caesarean rates among nulliparous women in spontaneous and induced labour, Robson groups 1 and 2A, were 7.8% (151/1925) and 32.6% (437/1339) respectively and among multiparous (excluding those women with a previous caesarean section), Robson group 3 and 4A were 1%(24/2389) and 4.4% (44/1005), respectively. Pre labour caesarean rates for nulliparous and multiparous women, Robson groups 2B and 4B 2 were 3.9% (133/3397) and 2.8% (100/3494), of the respective single cephalic cohort at term. Conclusion: The data strongly suggests that studies on induction of labour should be analyzed by parity and should probably be confined to nulliparous women.

scholarly journals Classification of caesarean section based on Robson ten group classification system in our hospital

2020 ◽  
Vol 9 (10) ◽  
pp. 4232
Author(s):  
Ari Sharma ◽  
Dipika Singh ◽  
Sarika Verma ◽  
Sanjog Sharma
Keyword(s):  
Caesarean Section ◽  
Classification System ◽  
Caesarean Section Rate ◽  
Group Classification ◽  
Health Concern ◽  
New Delhi ◽  
Group V ◽  
Nulliparous Women ◽  
Group I ◽  
Spontaneous Labour

Background: Recent data indicate that one in five women undergo caesarean section (CS). In the last decade, there has been a dramatic increase in the caesarean section rate worldwide, which now exceeds 30% in some regions. Thus, the increasing rate of caesarean section became a matter of international public health concern. Our study aimed to classify the CS-based on Robson ten group classification system (RTGCS) criteria which will subsequently enable us to standardise the indication of CS and establish protocols to reduce the number of CS in our set up.Method: A retrospective study was conducted in ESI Hospital, New Delhi wherein Robson TGCS was used to classify CS for 15 months (January 2019 to April 2020).Results: Overall CS rate in our hospital over the specified period was 34.5%. All women with one or more previous cesareans (group V) had the maximum number of cesareans, 37%, followed by nulliparous, single, cephalic, term pregnancy (induced) i.e group II, 22.1% and nulliparous women more than 37 weeks in spontaneous labour (group I), 9.5%.Conclusions: RTGCS is easy to comprehend and reproduce. All deliveries and cesareans should be universally categorized by the Robsons TGCS. An attempt should be made to evaluate the group contributing most to the CS rate and interventions should be made accordingly.

scholarly journals Analysis of Caesarean section rate in a government teaching institute based on Robson’s ten group classification

2018 ◽  
Vol 8 (1) ◽  
pp. 140
Author(s):  
Kavita Sambharam ◽  
Mansi Lalit Verma ◽  
Pradip W. Sambarey
Keyword(s):  
Caesarean Section ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Relative Size ◽  
Group Classification ◽  
Present System ◽  
Maternal Characteristics ◽  
Care Indicator ◽  
Spontaneous Labour ◽  
Group 5

Background: Caesarean section rate is a qualitative health care indicator in India. With increasing rates of caesarean sections and no defined method to audit present institutes it is the need of the hour to use tools like Robson’s classification to understand present system. The aim of this study was to determine the rate and analyse Caesarean sections in a tertiary care institute using Robson’s ten group classification system.Methods: This is a retrospective analytical study in which all Caesarean section done over a period of 3 years (July 2014-June 2017) were included which were performed in single unit (out of 6) of Department of Obstetrics and Gynecology of Sassoon General Hospital. Women were classified in 10 groups according to Robson’s classification, using maternal characteristics and obstetrical history. For each group, authors calculated its relative size and its contribution to the overall caesarean rate.Results: Total deliveries were 4750 out of which 985 were Caesarean section, incidence was calculated as 20.7%. The main contributors to the overall Caesarean rate were primiparous women in spontaneous labour (group 1- {18.3%}) and women with previous caesarean section (group 5- {34.9%}).Conclusions: The Robson’s classification is an easy tool to use and identify the current changing dynamics in any hospital setup. Its implementation as an obstetric audit can help lower the Caesarean rates and improve the standards based on WHO criteria.

scholarly journals Caesarean section rates analysed using Robson’s 10-Group Classification System: a cross-sectional study at a tertiary hospital in Ethiopia

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e039098
Author(s):  
Abdella Amano Abdo ◽  
Sven Gudmund Hinderaker ◽  
Achamyelesh Gebretsadik Tekle ◽  
Bernt Lindtjørn
Keyword(s):  
Classification System ◽  
Cross Sectional Study ◽  
Group Classification ◽  
Referral Hospital ◽  
Sectional Study ◽  
Singleton Pregnancy ◽  
Cross Sectional ◽  
Spontaneous Labour ◽  
Multiparous Women ◽  
Hawassa University

ObjectiveThe aim of this study was to assess the caesarean section (CS) rates using Robson’s 10-Group Classification System among women who gave birth at Hawassa University Referral Hospital in southern Ethiopia.DesignCross-sectional study design to determine CS rate using Robson’s 10-Group Classification System.SettingHawassa University Referral Hospital in south Ethiopia.Participants4004 women who gave birth in Hawassa University Referral Hospital from June 2018 to June 2019.ResultsThe 4004 women gave birth to 4165 babies. The overall CS rate was 32.8% (95% CI: 31.4%–34.3%). The major contributors to the overall CS rates were: Robson group 1 (nulliparous women with singleton pregnancy at term in spontaneous labour) 22.9%; group 5 (multiparous women with at least one previous CS) 21.4% and group 3 (multiparous women without previous CS, with singleton pregnancy in spontaneous labour) 17.3%. The most commonly reported indications for CS were ‘fetal compromise’ (35.3%) followed by previous CS (20.3%) and obstructed labour (10.7%).ConclusionA high proportion of women giving birth at this hospital were given a CS, and many of them were in a low-risk group. Few had trial of labour. More active use of partogram, improving fetal heartbeat-monitoring system, implementing midwife-led care, involving a companion during labour and auditing the appropriateness of CS indications may help to reduce the CS rate.

scholarly journals Caesarean Section Analysis of the Rate According to Robson Ten Group Classification

2021 ◽  
Vol 8 (01) ◽  
pp. 37-42
Author(s):  
Srividhya R ◽  
Jhansi Rani K
Keyword(s):  
Caesarean Section ◽  
Classification System ◽  
Placenta Previa ◽  
Caesarean Section Rate ◽  
Relative Size ◽  
Group Classification ◽  
Nulliparous Women ◽  
Increased Risk ◽  
Group 5 ◽  
Group 1

BACKGROUND In current and subsequent births, Caesarean sections bear their own risks for maternal and perinatal morbidity and mortality. In contrast with vaginal delivery, Caesarean section has increased risk of blood transfusion, hysterectomy and death and the risk of uterine rupture, placenta accreta and placenta previa in future pregnancies is also increased. We wanted to analyse the Caesarean section rate using Robson ten group classification system & identify the leading groups contributing to high caesarean section rates using Robson ten group classification system. METHODS This observational descriptive study enrolled 11,090 women who underwent delivery, of whom 5117 (46.14 %) women delivered vaginally and 5973 (53.86 %) women delivered through Caesarean section. RESULTS Overall caesarean section percentage was 53.86 %. Major contributors for the CSR were Group 5, 2 and 1 in that order. CS rate in Group 5 and 1 is relatively increased. Ratio of relative size of Group 1 and 2 is 1:2 indicating a greater number of prelabour caesarean sections in nulliparous women. Caesarean section rate in Group 1 and 2 was 15.7 % and 20.1 % respectively. The main indications for caesarean sections being fetal distress, non-progressive labour and severe oligohydramnios / anamnios. Relative size of Group 1 and 5 was 47.3 % stating that most of the obstetric population was in Group 1 and 5. Caesarean section rate in Group 3 and Group 4 was relatively higher than expected; this may be due to our institute being a referral center. Group 5 contributed 45.7 % to overall caesarean section rate. CONCLUSIONS Standardisation of indication of Caesarean deliveries, regular audits and definite protocols in hospital will aid in decreasing the Caesarean section rate in hospital. KEYWORDS Kidney Size, Ultrasound Assessment, Age Groups

Prolonged interpregnancy interval: how does it impact the length of second stage of labor?

2020 ◽  
Vol 48 (8) ◽  
pp. 811-818
Author(s):  
Nicole B. Kurata ◽  
Keith K. Ogasawara ◽  
Kathryn L. Pedula ◽  
William A. Goh
Keyword(s):  
Perinatal Outcomes ◽  
Kaiser Permanente ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Labor Duration ◽  
Nulliparous Women ◽  
Multiparous Women ◽  
Comparison Groups ◽  
Maternal And Neonatal Outcomes ◽  
Interpregnancy Intervals

AbstractObjectivesShort interpregnancy intervals (IPI) have been linked to multiple adverse maternal and neonatal outcomes, but less is known about prolonged IPI, including its relationship with labor progression. The objective of the study was to investigate whether prolonged IPIs are associated with longer second stages of labor.MethodsA perinatal database from Kaiser Permanente Hawaii was used to identify 442 women with a prolonged IPI ≥60 months. Four hundred forty two nulliparous and 442 multiparous women with an IPI 18–59 months were selected as comparison groups. The primary outcome was second stage of labor duration. Perinatal outcomes were compared between these groups.ResultsThe median (IQR) second stage of labor duration was 76 (38–141) min in nulliparous women, 15 (9–28) min in multiparous women, and 18 (10–38) min in women with a prolonged IPI (p<0.0001). Pairwise comparisons revealed significantly different second stage duration in the nulliparous group compared to both the multiparous and prolonged IPI groups, but no difference between the multiparous and prolonged IPI groups. There was a significant association with the length of the IPI; median duration 30 (12–61) min for IPI ≥120 months vs. 15 (9–27) min for IPI 18–59 months and 16 (9–31) min for IPI 60–119 months (p=0.0014).ConclusionsThe second stage of labor did not differ in women with a prolonged IPI compared to normal multiparous women. Women with an IPI ≥120 months had a significantly longer second stage vs. those with a shorter IPI. These findings provide a better understanding of labor progression in pregnancies with a prolonged IPI.

The level of unpleasantness of pain influences the choice of home treatment during medical abortion

2011 ◽  
Vol 2 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Satu Suhonen ◽  
Marja Tikka ◽  
Seppo Kivinen ◽  
Timo Kauppila
Keyword(s):  
Medical Abortion ◽  
Nulliparous Women ◽  
Home Based ◽  
Vaginal Deliveries ◽  
Multiparous Women ◽  
Induced Abortions ◽  
Pain Drawings ◽  
Nonopioid Analgesics ◽  
Post Abortion ◽  
At Home

AbstractBackground and aimsMedical abortion is often performed at outpatient clinics or gynaecological wards. Yet, some women may stay at home during medical abortion. Pain has been reported to be one of the main side effects of the procedure.MethodsWe studied whether perceived abortion pain was related to the subjectively evaluated ability to stay at home during medical abortion. The size of the study group was 29 women. We also studied how well these women remembered the intensity and unpleasantness of the abortion pain in a control visit performed 3–6 weeks after abortion.ResultsEspecially, the unpleasantness associated with the pain during abortion was an important predictor when women evaluated their ability to stay at home during medical abortion. In those women who might have been able to stay at home in their own view, midwives looking after these women at the outpatient clinic estimated the pain intensity and unpleasantness also about 50% lower than in those who were not able to stay home in their own view. There were no significant differences in intensity, unpleasantness in hindsight of menstruation pain, or the area of this pain in the pain drawings in those women who considered that they might have stayed at home during medical abortion when compared with those who did not. No difference was found in age, gestational age, magnitude of previous pregnancies, miscarriages, vaginal deliveries, induced abortions, Beck’s Depression Index (BDI), Beck’s Anxiety Index (BAI) or AUDIT scores between those who could have stayed at home or those who would not have been able to stay at home during abortion. Components of abortion pain decreased significantly during the second post-abortion day. The more deliveries the subject had experienced the less pain she had during abortion. Multiparous women reported less than a fourth of the pain magnitude of the nulliparous women during abortion. Parity explained both intensity and unpleasantness of abortion pain better than the expected ability to stay at home. The remembrance of the intensity or unpleasantness of abortion pain correlated with actual pain reported at the time of abortion. However, this remembrance did not correlate with the ability to stay at home during the medical abortion.ConclusionsThe unpleasantness of pain during and immediately after abortion was recalled, not as a measure of the pain itself, but as a deciding factor in their judgement of whether or not they would be able to undergo medical abortion at home. Abortion pain is an important factor in enhancing home-based management of medical abortions. Medical staff may be able to detect those women who do not cope at home during the process by observing the intensity of pain. Therefore, proper treatment of pain might reduce the need for hospital-based medical abortions.ImplicationsThese patients need better care and guidelines for the care of women undergoing medical abortions should include clear recommendations for analgesic treatments, at the least adequate doses of nonopioid analgesics such as paracetamol in combination with NSAIDs like ibuprofen or diclofenac.

scholarly journals Prediction of vaginal delivery with transperineal ultrasound in women induced with dinoprostone beyond 40 weeks of gestation

2018 ◽  
Vol 7 (8) ◽  
pp. 2998
Author(s):  
Hale Göksever Çelik ◽  
Engin Çelik ◽  
Gökhan Yıldırım
Keyword(s):  
Pregnant Women ◽  
Vaginal Delivery ◽  
Prospective Observational Study ◽  
Transperineal Ultrasound ◽  
Direct Visualization ◽  
Fetal Head ◽  
Nulliparous Women ◽  
Multiparous Women ◽  
High Possibility ◽  
Angle Of Progression

Background: Digital cervical evaluation has been used to determine the likelihood of vaginal delivery which is considered by many women to be non-tolerable. Recently, transperineal ultrasound allowing direct visualization of the fetal skull has been using for the prediction of labor route. Authors aimed to study whether measurements on transperineal ultrasound are predictive for vaginal delivery in pregnant women induced with dinoprostone at 40.0-42.0 gestational weeks.Methods: A total of 55 pregnant women at 40.0-42.0 gestational weeks were enrolled in this prospective observational study. All participated women were examined before the induction with dinoprostone to measure the head-perineum distance (HPD), the head-pubis distance and the angle of progression of fetal head (AOP).Results: The greater AOP, the shorter HPD and the head-pubis distance were associated with vaginal delivery in the nulliparous women. The HPD and the head-pubis distance were shorter, whereas the AOP was greater in the multiparous women giving birth by vaginal route.Conclusions: Transperineal ultrasound can be applied at the beginning of labor to predict whether vaginal delivery will occur or not. As shown in our study, the pregnant women with shorter HPD and wider AOP might have a high possibility to achieve vaginal delivery.

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