Interest in the Classification of Caesarean Section According to Robson at Teaching Hospital GABRIEL TOURE at Bamako, Mali

Abstract

Caesarean section rates (CSR) are steadily increasing worldwide with levels exceeding the maximum recommended by the WHO. To identify factors that may contribute to the improvement of CSR and to ensure an audit and feedback mechanism, we conducted this study of C-section according to Robson’s classification that identifies 10 mutually exclusive groups based on obstetric characteristics. This was a cross-sectional study from January 1, 2003 to December 31, 2013 on parturients who gave birth in the obstetrics department of the Gabriel TOURE University Teaching Hospital (UTH), which is a 3rd level health structure. We recorded 28,376 deliveries with 9,509 cases of C-section, with a rate of 33.5% (9,509/28,376). Robson's classes 3, 1, 5 and 10 constituted the largest populations and were the greatest contributors to the overall CSR with 7.6%, 7.4%, 5.9% and 5.4% respectively. The emergency admission (evacuation) rate was particularly high among Robson classes 5 and 3 with 57.1% and 46.6% of parturients evacuated, respectively. Classes 1, 3, and 10 had the highest number of cases and indications for emergency C-section. We recorded 298 cases of maternal death or 1.05% (298/28,376) of which 180 or 1.9% (180/9,509) of maternal death related to C-section, it was higher in groups 1, 3 and 10 with respectively 17.8%, 26.6% and 31.6% of cases of death. For fetal prognosis, the overall rate of stillbirth by C-section was 9.2% and was worse in groups 10, 7, 3 and 4 with 23.2%, 10.7%, 9.8% and 9.2% of stillbirths respectively. The stillbirth rate was higher in classes 9 and 10.